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Low level of education is associated with later stage at diagnosis and reduced survival in cutaneous malignant melanoma: A nationwide population-based study in Sweden

Eriksson, H.; Lyth, J.; Mansson-Brahme, E.; Frohm-Nilsson, M.; Ingvar, Christian LU ; Lindholm, C.; Naredi, P.; Stierner, U.; Wagenius, G. and Carstensen, J., et al. (2013) In European Journal of Cancer 49(12). p.2705-2716
Abstract
Background: A worse outcome has been reported for cutaneous malignant melanoma (CMM) patients with low socioeconomic status. We have investigated the association between level of education, clinical stage at diagnosis (stage at diagnosis) and CMM-specific survival in Sweden. Methods: We identified 27,235 patients from the Swedish Melanoma Register diagnosed with a primary invasive CMM between 1990 and 2007 and linked data to nationwide, population-based, health and census registers with a follow-up to 2010. Results: The odds ratio (OR) of higher disease stage at diagnosis was significantly increased in lower education groups (OR stage II versus I = 1.6; 95% confidence interval (CI) = 1.5-1.7. OR stage III-IV versus I = 2.3; 95% CI =... (More)
Background: A worse outcome has been reported for cutaneous malignant melanoma (CMM) patients with low socioeconomic status. We have investigated the association between level of education, clinical stage at diagnosis (stage at diagnosis) and CMM-specific survival in Sweden. Methods: We identified 27,235 patients from the Swedish Melanoma Register diagnosed with a primary invasive CMM between 1990 and 2007 and linked data to nationwide, population-based, health and census registers with a follow-up to 2010. Results: The odds ratio (OR) of higher disease stage at diagnosis was significantly increased in lower education groups (OR stage II versus I = 1.6; 95% confidence interval (CI) = 1.5-1.7. OR stage III-IV versus I = 2.3; 95% CI = 1.8-2.9). The risk of dying of CMM, was significantly increased in patients with low (hazard ratio (HR) low versus high = 2.02; 95% CI = 1.80-2.26; p < 0.0001) and intermediate (HR intermediate versus high = 1.35; 95% CI = 1.20-1.51; p < 0.0001) level of education. After adjustment for age, gender, stage at diagnosis and other known prognostic factors, the HRs remained significant for low versus high (HR = 1.13; 95% CI = 1.01-1.27; p = 0.04) but not for intermediate versus high (HR = 1.11; 95% CI = 0.99-1.24; p = 0.08) education. The HR associated with low level of education was significantly higher among female patients, patients <55 years, patients with truncal tumours and during the first 5 years after diagnosis. Conclusion: Lower level of education is associated with reduced CMM-specific survival, which may at least partially be attributed to a more advanced stage at diagnosis. These results emphasise the need for improved early detection strategies. (C) 2013 Elsevier Ltd. All rights reserved. (Less)
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published
subject
keywords
Melanoma, Survival, Socioeconomic status, Level of education, Stage at, diagnosis, Population-based
in
European Journal of Cancer
volume
49
issue
12
pages
2705 - 2716
publisher
IFAC & Elsevier Ltd.
external identifiers
  • wos:000321336800010
  • scopus:84879958786
ISSN
1879-0852
DOI
10.1016/j.ejca.2013.03.013
language
English
LU publication?
yes
id
4fe64b3b-3ad0-4045-8f84-c1bf3df2c46c (old id 3975504)
date added to LUP
2013-09-02 07:36:05
date last changed
2019-10-08 01:21:17
@article{4fe64b3b-3ad0-4045-8f84-c1bf3df2c46c,
  abstract     = {Background: A worse outcome has been reported for cutaneous malignant melanoma (CMM) patients with low socioeconomic status. We have investigated the association between level of education, clinical stage at diagnosis (stage at diagnosis) and CMM-specific survival in Sweden. Methods: We identified 27,235 patients from the Swedish Melanoma Register diagnosed with a primary invasive CMM between 1990 and 2007 and linked data to nationwide, population-based, health and census registers with a follow-up to 2010. Results: The odds ratio (OR) of higher disease stage at diagnosis was significantly increased in lower education groups (OR stage II versus I = 1.6; 95% confidence interval (CI) = 1.5-1.7. OR stage III-IV versus I = 2.3; 95% CI = 1.8-2.9). The risk of dying of CMM, was significantly increased in patients with low (hazard ratio (HR) low versus high = 2.02; 95% CI = 1.80-2.26; p &lt; 0.0001) and intermediate (HR intermediate versus high = 1.35; 95% CI = 1.20-1.51; p &lt; 0.0001) level of education. After adjustment for age, gender, stage at diagnosis and other known prognostic factors, the HRs remained significant for low versus high (HR = 1.13; 95% CI = 1.01-1.27; p = 0.04) but not for intermediate versus high (HR = 1.11; 95% CI = 0.99-1.24; p = 0.08) education. The HR associated with low level of education was significantly higher among female patients, patients &lt;55 years, patients with truncal tumours and during the first 5 years after diagnosis. Conclusion: Lower level of education is associated with reduced CMM-specific survival, which may at least partially be attributed to a more advanced stage at diagnosis. These results emphasise the need for improved early detection strategies. (C) 2013 Elsevier Ltd. All rights reserved.},
  author       = {Eriksson, H. and Lyth, J. and Mansson-Brahme, E. and Frohm-Nilsson, M. and Ingvar, Christian and Lindholm, C. and Naredi, P. and Stierner, U. and Wagenius, G. and Carstensen, J. and Hansson, J.},
  issn         = {1879-0852},
  keyword      = {Melanoma,Survival,Socioeconomic status,Level of education,Stage at,diagnosis,Population-based},
  language     = {eng},
  number       = {12},
  pages        = {2705--2716},
  publisher    = {IFAC & Elsevier Ltd.},
  series       = {European Journal of Cancer},
  title        = {Low level of education is associated with later stage at diagnosis and reduced survival in cutaneous malignant melanoma: A nationwide population-based study in Sweden},
  url          = {http://dx.doi.org/10.1016/j.ejca.2013.03.013},
  volume       = {49},
  year         = {2013},
}