INTRODUCTION
In the United States (US), the incidence of melanoma, the most aggressive and fatal type of skin cancer, has been increasing at an average rate of 1.4% annually over the last decade.1 Individuals with skin of color (SOC) have a markedly lower incidence of melanoma compared to their white counterparts.1 However, SOC patients suffer from worse clinical outcomes, including diagnosis at more advanced stages2 and consequently, lower rates of survival.3-5 SOC patients consistently present with later stages of melanoma, regardless of the location of the lesion.5 Barriers to obtaining medical care may contribute to challenges in early detection and appropriate management of melanoma. It is critical to investigate the determinants of timely access to healthcare to address gaps in diagnosis and treatment. This study aims to compare delays in access to medical care between SOC and white melanoma patients in the US and to characterize reasons for delayed care.
MATERIALS AND METHODS
We conducted a nationally representative, cross-sectional study utilizing the National Health Interview Survey from 2007–2018 in respondents with a self-reported history of melanoma skin cancer. Respondents were identified as SOC if they identified as Black, Asian, American Indian/Alaskan Native, or Native Hawaiian/Pacific Islander. Respondents were asked if they received delayed medical care in the past 12 months for the following reasons: 1) inability to obtain an appointment, 2) clinic not open, 3) unable to reach a physician/clinic by telephone, 4) lacked transportation, 5) wait was too long to see a physician. Multivariable logistic regression was used to model the odds of receiving delayed care. Analyses were performed using the svy suite of commands in Stata 15.0. Threshold for significance was set at P<0.05.
RESULTS
Among the 8,904,798 weighted respondents with melanoma, 266,641 (3.1%) self-identified as SOC (Table 1). Compared to white patients, a significantly greater percentage of SOC patients reported receiving delayed medical care due to inability to obtain appointment (18.9% vs 8.3%, P=0.0048), inability to reach the physician/clinic by phone (12.4% vs 2.7%, P=0.0001), lack of transportation (9.6% vs 1.6%, P=0.0001), and long wait time (10.3% vs 3.9%, P=0.0341; Table 1). SOC patients with melanoma were 2.27 times more likely to receive delayed access to medical care compared to white patients when controlling for age, sex, insurance status, income, education level, and region (aOR [95% CI]=2.27 [1.01-5.10]; Table 2).
DISCUSSION
Overall, our findings suggest that SOC individuals with melanoma have higher odds of obtaining delayed medical care compared to white melanoma patients. Delays in access to necessary healthcare services can exacerbate or partially explain previously established racial disparities in the detection, management, and survival of melanoma.4 Specifically, barriers in access may further prolong presentation and diagnosis at later stages. Furthermore, difficulty obtaining appropriate medical services can worsen delays in treatment; non-white patients have been shown to experience delays in surgical excision of melanoma compared to white patients.6 These factors may contribute to the lower melanoma-specific survival seen in SOC patients.3
Moreover, our study identified the inability to obtain an appointment (18.9%) and the inability to reach a clinic by telephone (12.4%) as common causes of receiving delayed care among SOC melanoma patients. Given that SOC patients
Moreover, our study identified the inability to obtain an appointment (18.9%) and the inability to reach a clinic by telephone (12.4%) as common causes of receiving delayed care among SOC melanoma patients. Given that SOC patients
