Disparities in melanoma-specific mortality by race/ethnicity, socioeconomic status, and health care systems

Background: Despite encouraging trends in survival, sociodemographic inequalities persist among patients with melanoma.Objective: We sought to quantify the effect of race/ethnicity, socioeconomic status, and health care systems on melanoma-specific mortality within an insured population of patients. Methods: Using a retrospective cohort study, we identified insured adults diagnosed with Stage I to IV melanoma from January 1, 2009, to December 31, 2014, followed through 2017, from the California Cancer Registry. We compared melanoma-specific mortality between insured patients diagnosed within the largest vertically integrated health care system in California, Kaiser Permanente Southern California, and insured patients with other private insurance (OPI).Results: Our cohort included 14,614 adults diagnosed with melanoma. Multivariable analyses demonstrated that race/ethnicity was not associated with survival disparities, while socioeconomic status was a strong predictor of melanoma-specific mortality, particularly for those with OPI. For example, hazard ratios demonstrate that the poorest patients with OPI have a 70% increased risk of dying from their melanoma compared to their wealthiest counterparts, while the poorest patients in Kaiser Permanente Southern California have no increased risk. Limitations: Our main limitation includes inadequate data for certain racial/ethnic groups, such as Native Americans.Conclusions: Our findings underscore the persistence of socioeconomic disparities within an insured population, specifically among those in non-integrated health care systems. ( J Am Acad Dermatol 2023;88:560-7.)