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Vilma E. Cokkinides, PhD; Alan C. Geller, MPH, RN; Ahmedin Jemal, PhD, DVM

Arch Dermatol. Published online January 16, 2012. doi:10.1001/archdermatol.2011.2779

Objective  To evaluate overall trends in melanoma mortality rates among non-Hispanic whites by educational level.

Design  Descriptive study.

Setting  Death certificate records from 26 states, representing approximately 45% of the US population as reported by the National Center for Health Statistics, with recorded educational level information and population data from the US Bureau of Census Current Population Survey.

Patients  Recorded deaths from malignant melanoma in non-Hispanic whites reported from 1993 through 2007.

Main Outcome Measures  Age-standardized mortality rates for melanoma were evaluated by educational attainment (a marker of socioeconomic status) among non-Hispanic whites (aged 25-64 years) from 1993 through 2007. Rate ratios assessed the time trend in age-adjusted death rates by sex and educational level. Mortality differentials in educational level were measured using the regression-based Relative Index of Inequality. All statistical tests were 2-sided.

Results  Melanoma mortality declined significantly between 1993-1997 and 2003-2007 in men (RR [rate ratio], 0.916; 95% CI, 0.878-0.954; P < .001) and women (RR, 0.907; 95% CI, 0.857-0.957; P < .001). However, these declines occurred only among the most educated persons (13 years of education irrespective of sex), and nonsignificant increases were found among the least-educated individuals, specifically men (P = .17). As a result, the Relative Index of Inequality by education in melanoma mortality in 2003-2007 relative to 1993-1997 (baseline) widened by 51.7% in men and by 35.7% in women.

Conclusions  Recent declines in melanoma mortality rates among non-Hispanic whites in the United States mainly reflect declines among the most-educated individuals. The widening disparities in melanoma mortality rates by education calls for early detection strategies to effectively target high-risk, less-educated, non-Hispanic white individuals.

Author Affiliations: Surveillance Research Program, American Cancer Society, Atlanta, Georgia (Drs Cokkinides and Jemal); and Division of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts (Mr Geller).

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