The role of spatially-derived access-to-care characteristics in melanoma prevention and control in Los Angeles county. (May 2017)

• Record Type: Journal Article
• Authors: Escobedo, Loraine A.; Crew, Ashley; Eginli, Ariana; Peng, David; Cousineau, Michael R.; Cockburn, Myles
• Is Part Of: Health & place. Volume 45(2017:May)
• Page Start: 160
• Page End: 172
• Publication Date: 2017-05
• Subjects: BA Bachelor's degree -- CI confidence interval -- CSP Cancer Surveillance Program -- CT census tract -- HMO Health Maintenance Organization -- HW Hispanic white -- LAC Los Angeles County -- NHW non-Hispanic white -- OR odds ratio -- PPO Preferred Provider Organization -- SES socioeconomic status -- U.S. United States -- USPSTF United States Preventive Services Task Force; Melanoma -- High-risk population -- Cancer surveillance data -- Health care accessibility -- Minority groups; Health -- Social aspects -- Periodicals; Health services accessibility -- Periodicals; Public health -- Periodicals; Political planning -- Periodicals; Social medicine -- Periodicals; Epidemiology -- Periodicals; Health Policy -- Periodicals; Health Services Accessibility -- Periodicals; Public Health -- Periodicals; Public Policy -- Periodicals; Sociology, Medical -- Periodicals; Épidémiologie -- Périodiques; Politique sanitaire -- Périodiques; Santé, Services de -- Accessibilité -- Périodiques; Health services accessibility; Health -- Social aspects; Political planning; Public health; Social medicine; Periodicals; 613
• DOI: 10.1016/j.healthplace.2017.01.004
• Languages: English
• ISSNs: 1353-8292

Abstract

Abstract: Among 10, 068 incident cases of invasive melanoma, we examined the effects of patient characteristics and access-to-care on the risk of advanced melanoma. Access-to-care was defined in terms of census tract-level sociodemographics, health insurance, cost of dermatological services and appointment wait-times, clinic density and travel distance. Public health insurance and education level were the strongest predictors of advanced melanomas but were modified by race/ethnicity and poverty: Hispanic whites and high-poverty neighborhoods were worse off than non-Hispanic whites and low-poverty neighborhoods. Targeting high-risk, underserved Hispanics and high-poverty neighborhoods (easily identified from existing data) for early melanoma detection may be a cost-efficient strategy to reduce melanoma mortality.