Examining the pathways linking lower socioeconomic status and advanced melanoma
Examining the pathways linking lower socioeconomic status and advanced melanoma
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DOI：
10.1002/cncr.26706
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发表时间：
2012-08-15
期刊：
影响因子：
6.2
通讯作者：
Geller, Alan C.
中科院分区：
文献类型：
--
作者：
Pollitt, Ricardo A.;Swetter, Susan M.;Geller, Alan C.
背景。低社会经济地位（SES）与诊断时更晚期的黑色素瘤和生存率降低有关。探索较低的社会经济地位和较厚的黑色素瘤之间的联系途径将有助于指导公共和专业策略以减少死亡。方法。作者调查了斯坦福大学医学中心、帕洛阿尔托退伍军人事务部医疗保健系统和密歇根大学的 566 名新诊断患者。 SES 根据教育水平进行评估（高中/普通教育学位或以下 [HS]、副学士学位/技术学校学位或 = 大学毕业生）。所有数据都是通过患者在诊断后三个月内的自我报告获得的。结果。受过 HS 教育的个体比大学毕业生更有可能相信黑色素瘤不是很严重（比值比 [OR]，2.90；95% 置信区间 [CI]，1.79-4.71），并且不太可能了解不对称性、边界（不规则）、颜色（杂色）和直径 (> 6 mm) (ABCD) 黑色素瘤规则或黑色素瘤与普通皮肤生长之间的差异 (OR，分别为 0.34 [95% CI，0.23-0.52] 和 0.26 [95% CI，0.16-0.41]）。与受过大学教育的人相比，医生不太可能告诉受过 HS 教育的人他们有患皮肤癌的风险（OR，0.46；95% CI，0.31-0.71）或指导他们如何检查皮肤是否有黑色素瘤迹象（OR，0.40；95% CI，0.25-0.63）。受过 HS 教育的个体在诊断前一年内接受医生皮肤检查的可能性较小（OR，0.54；95% CI，0.37-0.80）。结论。低社会经济地位个体中黑色素瘤风险认知和知识的减少以及这些个体皮肤检查方面医生沟通的减少可能是持续观察到的死亡率社会经济梯度的关键组成部分。目前的研究结果表明，需要提高社会经济地位较低的患者对黑色素瘤的认识，并提高医生对临床沟通和护理中社会经济差异的认识。癌症 2012。(c) 2011 美国癌症协会。
BACKGROUND. Low socioeconomic status (SES) is associated with more advanced melanoma at diagnosis and decreased survival. Exploring the pathways linking lower SES and thicker melanoma will help guide public and professional strategies to reduce deaths. METHODS. The authors surveyed 566 newly diagnosed patients at Stanford University Medical Center, Veterans Affairs Palo Alto Health Care System, and University of Michigan. SES was assessed by education level (high school/general education degree or less [HS], associate/technical school degree, or =college graduate). All data was obtained by self-report among patients within three months of their diagnosis. RESULTS. HS-educated individuals were significantly more likely than college graduates to believe that melanoma was not very serious (odds ratio [OR], 2.90; 95% confidence interval [CI], 1.79-4.71) and were less likely to know the asymmetry, borders (irregular), color (variegated), and diameter (>6 mm) (ABCD) melanoma rule or the difference between melanoma and ordinary skin growths (OR, 0.34 [95% CI, 0.23-0.52] and 0.26 [95% CI, 0.16-0.41] respectively). Physicians were less likely to have ever told HS-educated versus college-educated individuals they were at risk for skin cancer (OR, 0.46; 95% CI, 0.31-0.71) or instructed them on how to examine their skin for signs of melanoma (OR, 0.40; 95% CI, 0.25-0.63). HS-educated individuals were less likely to have received a physician skin examination within the year before diagnosis (OR, 0.54; 95% CI, 0.37-0.80). CONCLUSIONS. Decreased melanoma risk perception and knowledge among low-SES individuals and decreased physician communication regarding skin examinations of these individuals may be key components of the consistently observed socioeconomic gradient in mortality. The current findings suggest the need to raise melanoma awareness among lower-SES patients and to increase physician awareness of socioeconomic disparities in clinical communication and care. Cancer 2012.(c) 2011 American Cancer Society.