Risks of skin cancer in older adults: analysis of the English Longitudinal Study of Ageing. (November 2017) - Koopmans, Imogen
Abstract: Background: About half of melanoma skin cancers are diagnosed in people aged over 65 years. In the past decade, incidence in the UK has increased by 45%. Ultraviolet radiation is associated with 86% of UK malignant melanomas. We aimed to identify associations between skin cancer diagnosis and demographic, socioeconomic, and behavioural risk factors. Methods: The English Longitudinal Study of Ageing is a large cohort study of 17 980 people over the age of 50 years. Our analysis included all participants reporting melanoma or other skin cancer (excluding minor skin cancers) between March 1, 2002, and March 1, 2012. We tested the association between skin cancer and prespecified potential risk factors, including age, sex, education, health literacy, income, wealth, socioeconomic status, holidays abroad and in the UK, marriage, isolation, disability, body-mass index, physical activity, asthma, hormone replacement therapy, and smoking. Unadjusted, age-adjusted, and sex-adjusted logistic regression models were used to identify associations. Findings: 245 participants reported melanoma or other skin cancer diagnosis. A diagnosis of melanoma or other skin cancer was associated with each extra year of age (adjusted odds ratio 1·03, 95% CI 1·02–1·04) and being a current smoker versus being a non-smoker (0·50, 0·31–0·80). Holidaying in the UK was associated with melanoma or other skin cancer (1·44, 1·08–1·91), but holidaying abroad was not (1·19, 0·90–1·57). The UK holiday results persisted after further adjustment for wealth (1·38, 1·03–1·86) and socioeconomic status (1·38, 1·02–1·86). There was no association in the adjusted analysis for the other factors. Interpretation: Major skin cancer was associated with being a current smoker, which may be due to the carcinogenic impact. Our results also showed that holidaying in the UK, but not holidaying abroad, was associated with major skin cancer, which might be because of low perceived risk of skin damage when in the UK or other confounders. Public health advice should highlight the importance of skin protection even when in the UK. Funding: None.