| Description |
In the United States (US), melanoma is the 5th most common cancer and is increasing in the young adult populations. In 2015, the incidence of melanoma in Utah was 40.5 per 100,000 compared to 22.1 per 100,00 nationally, and the mortality rate was 2.6 cases per 100,000 compared to 2.1 cases per 100,000 nationally. We analyzed population-based incidence and mortality data from the Surveillance, Epidemiology, and End Results Program 18 (SEER) database and the Utah Cancer Registry (UCR). SEER and UCR data were used to evaluate the incidence and mortality rates in the US and Utah and the association between provider density and the risk of all-cause and melanoma-specific death. These analyses were stratified by urban versus rural status. In Utah, incidence was lower among non-Hispanics and patients diagnosed at an earlier stage of disease living in rural counties compared to urban counties. However, there was no significant difference in the mortality rates between urban and rural residents of Utah. Melanoma incidence continues to increase in the US and in Utah. In Utah, incidence has increased at a higher rate in rural counties of high SES status. Primary care physician density was associated with a reduction in all-cause mortality, and midlevel provider density was associated with a reduction in melanoma-specific death. Through the use of an ultraviolet radiation (UVR) wearable device, we assessed the UVR exposure experienced by adults and children in Utah. UVR exposure was significantly higher among rural adults for the entire study period and during peak UVR hours (10-4pm) at the 95th iv percentile. The median dose during peak UVR hours for the entire study period and per day on weekdays was significantly higher among rural children compared to urban children. The current study reported between differences in incidence and UVR exposure between rural and urban populations in Utah. By understanding some of the socioeconomic and geographical disparities in melanoma incidence mortality and UVR exposure, health interventions can be tailored to the specific needs the of each population. These dissertation pages were prepared for publication. |
