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Research Letters |

Geographic Distribution of Melanoma in Miami–Dade County, Florida:  Online First FREE

Natalie Yin, BS; Dorothy F. Parker, MHS; Shasa Hu, MD; Robert S. Kirsner, MD, PhD
[+] Author Affiliations

Author Affiliations: Department of Dermatology and Cutaneous Surgery (Ms Yin and Drs Hu and Kirsner), Sylvester Comprehensive Cancer Center, Disparities and Community Outreach Core (Ms Parker and Drs Hu and Kirsner), University of Miami Miller School of Medicine, Miami, Florida.


Arch Dermatol. 2011;147(5):617-618. doi:10.1001/archdermatol.2010.412.
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Our research group1 has demonstrated disparities in stage at diagnosis for melanoma based on race and ethnicity and on health care delivery system. To further document these disparities, we examine herein data for Miami–Dade County, Florida.

Miami–Dade County, the most populous of Florida's 67 counties, has more than 2.5 million residents. The socioeconomic status (SES) characteristics of this county include factors that may affect health care access and utilization, such as a diverse racial and ethnic population, a large indigent population, and large percentages of foreign-born individuals.2 We sought to determine if, within the county, differences exist in stage of melanoma diagnosis and if so, what factors influence those differences.

Incidence data on melanoma as the primary site of diagnosis for the 5-year period from 1997 through 2001 were extracted from the Florida Cancer Data System (FCDS),3 Florida's statewide, population-based cancer incidence registry. In the FCDS, stage at diagnosis is coded according to the summary staging system used by the SEER (Surveillance Epidemiology and End Results) program.4 For the present analysis, in situ and local stage diagnoses (stages 0 and 1) were considered early, while regional and distant or systemic diagnoses (stages 2-4) were considered late. Cases with unknown stage were excluded.

We used zip code of residence for each case to subdivide the county. Zip codes were used rather than census tracts because they represent larger populations and numbers of melanoma cases, although population sizes of zip code areas vary slightly.5 Zip codes are also recognizable to the general public, planners, and policy makers, and there is precedence for using zip codes in similar evaluations.68

Zip code population data were obtained from the US Census 20009 for population and housing, summary file 3, technical documentation 2002. Ten SES measures were extracted from this source for each of the 76 residential zip codes in Miami–Dade County (except for item 6, which was extracted from the Florida Agency for Health Care Administration10) (Table). We also developed zip code maps of Miami–Dade County using ArcMap, version 8.3 (Esri, Redlands, California) for each of the 10 SES measures.

Table Graphic Jump LocationTable. Sociodemographic Variables Extracted for Each of the 76 Residential Zip Codesa

Using data aggregated by zip code, we computed 2-tailed Pearson correlation coefficients using SPSS, version 15.0 (IBM Corporation, Somers, New York) to examine SES factors that were correlated with the percentage of melanoma late-stage diagnoses. Multiple logistic regressions were performed to further examine how the SES variables were related to stage at diagnosis, coded as either early or late. The analysis was performed on individual case data. The SES measures used were for the zip codes in which the individual lived, not for the individual patient. Ecologic analyses are commonly used when socioeconomic data for individual patients are not available.

Our study included 1009 cases of melanoma, 26% of which were diagnosed at late stage. Distribution of late-stage diagnoses for melanoma tended to be clustered by zip codes (Figure). After controlling for socioeconomic factors, we found that zip codes with higher percentages of Hispanic residents (r = 0.275) were positively correlated with late-stage diagnosis (P < .01).

Place holder to copy figure label and caption
Figure.

Distributions of late-stage melanoma diagnoses and Hispanic population by zip code, Miami–Dade County, Florida, 1997 through 2001.

Graphic Jump Location

Late-stage melanoma cases in Miami–Dade County showed a significant geographical clustering. This finding suggests a critical need for increased educational programs and/or medical involvement in these areas tailored to address the sociodemographic characteristics of each area. Using similar analytic techniques, other researchers12 have demonstrated similar geographic patterns for breast cancer.12

The reasons for the distribution of late-stage diagnoses found in the present study were not examined. However, our findings are consistent with previous studies in which other researchers13 found that patients with melanoma who live in areas with lower incomes, a majority nonwhite population, or a majority of residents without high school degrees have worse prognoses. These same authors also reported that local education influences melanoma prognosis.

We found that Hispanic origin was correlated with late-stage diagnosis, which suggests that Hispanic origin in Miami–Dade County could serve as a predictor of areas at risk. While we did not evaluate individual patients with late-stage melanoma diagnoses but rather zip code areas, the present results are consistent with our group's previous findings1 that Hispanics perceive themselves at lower risk of developing melanoma, even after skin cancer risk factors including skin type are controlled for. Hispanics also are less knowledgeable about melanoma, less likely to perform self-examinations, and often unaware of the clinical signs of skin cancer; they have worse outcomes. The worse outcomes are to result from issues of health care delivery, but the possibility exists that melanomas in Hispanics may be more biologically aggressive. The exact reasons underlying the correlation between geographic clustering of late-stage melanoma diagnoses and Hispanics are not yet known and would be important to investigate in future studies.

Correspondence: Dr Kirsner, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave, RMSB, Room 2023-A, Miami, FL 33136 (rkirsner@med.miami.edu).

Published Online: January 17, 2011. doi:10.1001/archdermatol.2010.412

Accepted for Publication: November 8, 2010.

Author Contributions: Dr Kirsner had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Parker and Kirsner. Acquisition of data: Parker and Kirsner. Analysis and interpretation of data: Yin, Parker, Hu, and Kirsner. Drafting of the manuscript: Yin and Parker. Critical revision of the manuscript for important intellectual content: Hu and Kirsner. Obtained funding: Kirsner. Administrative, technical, and material support: Parker and Kirsner. Study supervision: Kirsner.

Financial Disclosure: None reported.

Funding/Support: This study was supported by the Centers for Disease Control and Prevention.

Role of the Sponsors: The sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of data; or in the preparation, review, or approval of the manuscript.

Rouhani  PHu  SKirsner  RS Melanoma in Hispanic and black Americans. Cancer Control 2008;15 (3) 248- 253
PubMed
Kirsner  RS Cancer among indigent populations in Miami-Dade County: final report to the American Cancer Society, Florida Division, Inc. http://sfccc.med.miami.edu/30 July2010;
Sylvester Comprehensive Cancer Center; Florida Department of Health, Florida Cancer Data System. http://fcds.med.miami.edu/inc/idea.shtml#30 July2010;
National Cancer Institute, SEER Summary Stage 2000: melanoma of the skin, vulva, penis and scrotum staging. http://training.seer.cancer.gov/melanoma/abstract-code-stage/staging.html30 July2010;
Wang  F McLafferty  SEscamilla  VLuo  L Late-stage breast cancer diagnosis and health care access in Illinois. Prof Geogr 2008;60 (1) 54- 69
PubMed
Ng  EWilkins  RPerras  A How far is it to the nearest hospital? Calculating distances using the Statistics Canada Postal Code Conversion File. Health Rep 1993;5 (2) 179- 188
PubMed
Parker  EBCampbell  JL Measuring access to primary medical care: some examples of the use of geographical information systems. Health Place 1998;4 (2) 183- 193
PubMed
Knapp  KKHardwick  K The availability and distribution of dentists in rural ZIP codes and primary care health professional shortage areas (PCHPSA) ZIP codes: comparison with primary care providers. J Public Health Dent 2000;60 (1) 43- 48
PubMed
US Census Bureau, Your gateway to Census 2000. http://www.census.gov/main/www/cen2000.html30 July2010;
Lazarus  WFoust  BHitt  BFlorida Agency for Health Care Administration, The Florida Health Insurance Study: Small Area Analysis.  Tallahassee, FL State of Florida Agency for Health Care Administration;2000;
US Census Bureau, Summary file 3. http://www.census.gov/census2000/sumfile3.html30 July2010;
Kulldorff  MFeuer  EJMiller  BAFreedman  LS Breast cancer clusters in the northeast United States: a geographic analysis. Am J Epidemiol 1997;146 (2) 161- 170
PubMed
Eide  MJWeinstock  MAClark  MA Demographic and socioeconomic predictors of melanoma prognosis in the United States. J Health Care Poor Underserved 2009;20 (1) 227- 245
PubMed

Figures

Place holder to copy figure label and caption
Figure.

Distributions of late-stage melanoma diagnoses and Hispanic population by zip code, Miami–Dade County, Florida, 1997 through 2001.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable. Sociodemographic Variables Extracted for Each of the 76 Residential Zip Codesa

References

Rouhani  PHu  SKirsner  RS Melanoma in Hispanic and black Americans. Cancer Control 2008;15 (3) 248- 253
PubMed
Kirsner  RS Cancer among indigent populations in Miami-Dade County: final report to the American Cancer Society, Florida Division, Inc. http://sfccc.med.miami.edu/30 July2010;
Sylvester Comprehensive Cancer Center; Florida Department of Health, Florida Cancer Data System. http://fcds.med.miami.edu/inc/idea.shtml#30 July2010;
National Cancer Institute, SEER Summary Stage 2000: melanoma of the skin, vulva, penis and scrotum staging. http://training.seer.cancer.gov/melanoma/abstract-code-stage/staging.html30 July2010;
Wang  F McLafferty  SEscamilla  VLuo  L Late-stage breast cancer diagnosis and health care access in Illinois. Prof Geogr 2008;60 (1) 54- 69
PubMed
Ng  EWilkins  RPerras  A How far is it to the nearest hospital? Calculating distances using the Statistics Canada Postal Code Conversion File. Health Rep 1993;5 (2) 179- 188
PubMed
Parker  EBCampbell  JL Measuring access to primary medical care: some examples of the use of geographical information systems. Health Place 1998;4 (2) 183- 193
PubMed
Knapp  KKHardwick  K The availability and distribution of dentists in rural ZIP codes and primary care health professional shortage areas (PCHPSA) ZIP codes: comparison with primary care providers. J Public Health Dent 2000;60 (1) 43- 48
PubMed
US Census Bureau, Your gateway to Census 2000. http://www.census.gov/main/www/cen2000.html30 July2010;
Lazarus  WFoust  BHitt  BFlorida Agency for Health Care Administration, The Florida Health Insurance Study: Small Area Analysis.  Tallahassee, FL State of Florida Agency for Health Care Administration;2000;
US Census Bureau, Summary file 3. http://www.census.gov/census2000/sumfile3.html30 July2010;
Kulldorff  MFeuer  EJMiller  BAFreedman  LS Breast cancer clusters in the northeast United States: a geographic analysis. Am J Epidemiol 1997;146 (2) 161- 170
PubMed
Eide  MJWeinstock  MAClark  MA Demographic and socioeconomic predictors of melanoma prognosis in the United States. J Health Care Poor Underserved 2009;20 (1) 227- 245
PubMed

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