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Publication Date

2008-06-19

Availability

UM campus only

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Epidemiology (Medicine)

Date of Defense

2008-05-30

First Committee Member

Lora E. Fleming - Committee Chair

Second Committee Member

Kris Arheart - Committee Member

Third Committee Member

Jill MacKinnon - Committee Member

Fourth Committee Member

Robert S. Kirsner - Mentor

Abstract

Melanoma is among the top ten most common cancers in the US. The health care delivery system patients participate in may affect access to, and utilization of, health care resources that may determine health outcomes. Much of the current literature has addressed lighter-skinned populations since these individuals are at greatest risk of developing melanoma. This Dissertation is focused on melanoma in nonwhite populations and the effect of health care delivery and access to care on outcome. Specifically, our aims were to review the literature in the area of melanoma among nonwhite populations and compare the incidence of melanoma among nonwhite populations in Florida to the US. Additionally, we sought to determine the stage of melanoma diagnosis for a 12 year period in fee-for-service (FFS) and health maintenance organizations (HMO), to determine if differences in mortality exist between these systems of health care delivery and if established involvement in a health care delivery system may, in part, be responsible for any differences seen in stage of diagnosis and survival. We found non-Hispanic black (NHB) females and Hispanic males in Florida had significantly higher incidence rates of invasive melanoma than their counterparts in the US, 60% and 20% respectively. We also found that Hispanic Medicare patients enrolled in HMO health care delivery systems were less likely to receive a diagnosis of regional versus earlier stages of melanoma compared to Hispanic patients enrolled in FFS systems. Additionally, non-Hispanic white (NHW) Medicare patients enrolled in HMO health care delivery systems were less likely to be diagnosed at a later stage of melanoma compared to NHW patients enrolled in FFS systems. Targeted educational interventions and earlier detection of melanoma are fundamental components of cancer prevention and control efforts aimed at decreasing mortality. More comprehensive medical training, expanded public education campaigns, and increased awareness among patients of all skin types to perform self-skin checks are highly recommended. Further studies elucidating the etiology and risk factors for melanoma among minority populations are needed. We recommend investigation of possible differences in the etiology of melanoma among darker-skinned individuals as well as differences between health care delivery systems.

Keywords

Melanoma Epidemiology; Cancer Disparities

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