Melanoma Death Rate Linked to Dermatologist Density
February 24, 2012 — In areas with a population of 100,000, mortality rates are lower if there are 1 or 2 dermatologists than if there are none, according to a report published in the February issue of the Archives of Dermatology.
Interestingly, there was no further benefit with more than 2 dermatologists, according to the study authors, led by Jeremy S. Bordeaux, MD, from Case Western Reserve University, Cleveland, Ohio. This finding suggests "a plateau effect with increasing physician supply," they write.
However, areas in the United States without a dermatologist — and there are many — are in need these professionals, Dr. Bordeaux and his coauthors report.
"We speculate that efforts to recruit dermatologists to counties currently lacking such specialists could result in a population-level reduction in melanoma mortality," they write.
The authors found that in areas with a population of 100,000 in the United States, having 1 dermatologist was associated with a 35% reduction in the mortality rate (P = .002), compared with having no dermatologists. When there was 1.001 to 2 dermatologists in an area, there was a 53% reduction (P < .001).
There were also reductions in the mortality rate when an area had more than 2 dermatologists, but the rate of reduction did not continue to increase. Having 2.001 to 4 dermatologists in an area was associated with a 36% reduction in the melanoma mortality rate. This was better than having no dermatologists at all, but was no better than having 2 dermatologists.
This study adds to the data demonstrating that physician density — especially that of specialists — influences healthcare outcomes, say Dr. Bordeaux and his coauthors.
Although it is not clear if dermatologist density improved melanoma mortality by way of prevention, diagnosis, or treatment, the authors write, a greater density is definitely associated with better outcomes.
The authors looked at melanoma incidence and mortality rates per 100,000 people in 2,472 American counties from 2002 to 2006.
The data were obtained from 3 sources and merged into a single set. The sources were the National Program for Cancer Registries; the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program; and the US Centers for Disease Control and Prevention's National Vital Statistics System.
The authors also presented the mortality reductions in absolute numbers.
In the reference group (no dermatologists per 100,000 people), the absolute melanoma mortality rate was 1.45 (P < .001), based on a prevalence of 19 cases per 100,000 people.
Having 1 dermatologist per 100,000 people was associated with a 0.51 absolute reduction in mortality (P = .002); having 1.001 to 2 dermatologists with a 0.77 absolute reduction (P < .001); having 2.001 to 4.0 dermatologists with a 0.56 absolute reduction (P < .001), and having more than 4 dermatologists with a 0.66 absolute reduction (P < .001).
These findings reinforce previous research that pointed to the importance of dermatologists in melanoma care, say the authors. For instance, a 2000 study found that that people with limited access to care were more likely to receive a late-stage melanoma diagnosis (J Am Acad Dermatol. 2000;43:211-218).
"Dermatologists treat the majority of melanoma patients in the United States," Dr. Bordeaux told Medscape Medical News, adding that "the majority of melanomas are caught early and most people diagnosed with melanoma live long happy lives."
Could primary care physicians (PCPs) help with detection?
Possibly, said Dr. Bordeaux, but there are 2 major barriers. "We do need to do a better job at educating PCPs as to what melanoma looks like. If they were more confident in their ability to diagnose melanoma, they may perform more skin exams. The second barrier is time. Our PCPs have so many different things that they are expected to do and little time to do them all," he said.
Big City Benefit
In the study, a "slightly" lower melanoma mortality rate was associated with the presence of hospitals with oncology departments (1.9%). Notably, a county with a major metropolitan area was associated with a 30.3% reduction in the mortality rate.
Melanoma mortality rates are greater in counties with a higher incidence of melanoma (2.3%), a larger white population (1.5%), and a larger health-insured population (1.5%).
Not associated with increased melanoma mortality rates are the density of PCPs, percentage of population older than 65 years, health professional shortage area classification, percentage of population older than 25 years with a high school diploma or equivalent, median household income, and unemployment rate.
In a large portion of the United States, there are no dermatologists per 100,000 people, the authors report.
Higher densities of dermatologists are found along the Pacific Coast, throughout the state of Hawaii, and in clusters along the East Coast and the Midwest. Significantly lower densities are in found the central United States.
Dr. Bordeaux is supported by the Dermatology Foundation Clinical Career Development Award in Dermatologic Surgery.
Arch Dermatol. 2012;148:174-178. Abstract
February 24, 2012 — In areas with a population of 100,000, mortality rates are lower if there are 1 or 2 dermatologists than if there are none, according to a report published in the February issue of the Archives of Dermatology.
Interestingly, there was no further benefit with more than 2 dermatologists, according to the study authors, led by Jeremy S. Bordeaux, MD, from Case Western Reserve University, Cleveland, Ohio. This finding suggests "a plateau effect with increasing physician supply," they write.
However, areas in the United States without a dermatologist — and there are many — are in need these professionals, Dr. Bordeaux and his coauthors report.
"We speculate that efforts to recruit dermatologists to counties currently lacking such specialists could result in a population-level reduction in melanoma mortality," they write.
The authors found that in areas with a population of 100,000 in the United States, having 1 dermatologist was associated with a 35% reduction in the mortality rate (P = .002), compared with having no dermatologists. When there was 1.001 to 2 dermatologists in an area, there was a 53% reduction (P < .001).
There were also reductions in the mortality rate when an area had more than 2 dermatologists, but the rate of reduction did not continue to increase. Having 2.001 to 4 dermatologists in an area was associated with a 36% reduction in the melanoma mortality rate. This was better than having no dermatologists at all, but was no better than having 2 dermatologists.
This study adds to the data demonstrating that physician density — especially that of specialists — influences healthcare outcomes, say Dr. Bordeaux and his coauthors.
Although it is not clear if dermatologist density improved melanoma mortality by way of prevention, diagnosis, or treatment, the authors write, a greater density is definitely associated with better outcomes.
The authors looked at melanoma incidence and mortality rates per 100,000 people in 2,472 American counties from 2002 to 2006.
The data were obtained from 3 sources and merged into a single set. The sources were the National Program for Cancer Registries; the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program; and the US Centers for Disease Control and Prevention's National Vital Statistics System.
The authors also presented the mortality reductions in absolute numbers.
In the reference group (no dermatologists per 100,000 people), the absolute melanoma mortality rate was 1.45 (P < .001), based on a prevalence of 19 cases per 100,000 people.
Having 1 dermatologist per 100,000 people was associated with a 0.51 absolute reduction in mortality (P = .002); having 1.001 to 2 dermatologists with a 0.77 absolute reduction (P < .001); having 2.001 to 4.0 dermatologists with a 0.56 absolute reduction (P < .001), and having more than 4 dermatologists with a 0.66 absolute reduction (P < .001).
These findings reinforce previous research that pointed to the importance of dermatologists in melanoma care, say the authors. For instance, a 2000 study found that that people with limited access to care were more likely to receive a late-stage melanoma diagnosis (J Am Acad Dermatol. 2000;43:211-218).
"Dermatologists treat the majority of melanoma patients in the United States," Dr. Bordeaux told Medscape Medical News, adding that "the majority of melanomas are caught early and most people diagnosed with melanoma live long happy lives."
Could primary care physicians (PCPs) help with detection?
Possibly, said Dr. Bordeaux, but there are 2 major barriers. "We do need to do a better job at educating PCPs as to what melanoma looks like. If they were more confident in their ability to diagnose melanoma, they may perform more skin exams. The second barrier is time. Our PCPs have so many different things that they are expected to do and little time to do them all," he said.
Big City Benefit
In the study, a "slightly" lower melanoma mortality rate was associated with the presence of hospitals with oncology departments (1.9%). Notably, a county with a major metropolitan area was associated with a 30.3% reduction in the mortality rate.
Melanoma mortality rates are greater in counties with a higher incidence of melanoma (2.3%), a larger white population (1.5%), and a larger health-insured population (1.5%).
Not associated with increased melanoma mortality rates are the density of PCPs, percentage of population older than 65 years, health professional shortage area classification, percentage of population older than 25 years with a high school diploma or equivalent, median household income, and unemployment rate.
In a large portion of the United States, there are no dermatologists per 100,000 people, the authors report.
Higher densities of dermatologists are found along the Pacific Coast, throughout the state of Hawaii, and in clusters along the East Coast and the Midwest. Significantly lower densities are in found the central United States.
Dr. Bordeaux is supported by the Dermatology Foundation Clinical Career Development Award in Dermatologic Surgery.
Arch Dermatol. 2012;148:174-178. Abstract
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