Socioeconomic status as a predictor of melanoma survival in a series of 1083 cases from Brazil: just a marker of health services accessibility?


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Abstract

Melanoma survival is determined by disease-related and patient-related factors; there is a growing body of evidence that other issues may play a role in this disease. In this study, the role of socioeconomic factors in the evolution of melanoma was evaluated. This was a retrospective study with incident cases of melanoma treated in an oncology center in Rio de Janeiro, Brazil, during the period of 1997–2004. The socioeconomic variable of choice was education (9 years or more vs. 8 years or less of school attendance). In this period, there were 1083 patients with primary melanoma of the skin, 58.1% with low school attendance. No difference was found in relation to the year of diagnosis with respect to overall survival. Five-year survival for the entire group was 67.0%. Men had worse survival [hazard ratio (HR) 1.91, 95% confidence interval (CI) 1.54–2.35]; a protective effect was found for whites (HR 0.64, 95% CI 0.49–0.84), higher educational level (HR 0.55, 95% CI 0.44–0.69), and upper limb lesions (HR 0.61, 95% CI 0.38–0.98). A higher risk of death was observed for patients with nodular melanoma (HR 1.96, 95% CI 1.49–2.58), acrolentiginous melanoma (HR 2.68, 95% CI 2.09–3.44), lesions in the soles and palms (HR 1.78, 95% CI 1.22–2.6), and increasing age (HR 1.02 for each year, 95% CI 1.01–1.02). In the multivariate analysis, after controlling for stage, age, sex, ethnicity, and clinical type, education remained a protective factor both for overall survival (HR 0.76, 95% CI 0.61–0.94) and for relapse-free survival (HR 0.76, 95% CI 0.61–0.94). In conclusion, socioeconomic status as measured by educational level represented an important factor related to melanoma clinical evolution in the cohort studied.

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