DESPITE advancements in cancer care, disparities persist in melanoma diagnosis and prognosis, particularly among individuals from lower socioeconomic backgrounds and rural areas. Research indicates that lower socioeconomic status (SES) is linked to thicker tumours (T4 disease), which correlates with poorer survival outcomes. Factors such as limited awareness of warning signs, barriers to healthcare access, and biases like lead-time and length biases contribute to these disparities.
The Veterans Health Administration (VHA), the largest integrated healthcare system in the United States, serves many individuals with low SES and rural backgrounds. Analysis of the US Department of Veterans Affairs (VA) Cancer Registry has shown that veterans in disadvantaged neighbourhoods are more likely to be diagnosed with advanced-stage melanoma. Using the area deprivation index (ADI), a measure of social vulnerability, researchers assessed the role of socioeconomic determinants of health (SDOH) in melanoma diagnosis and care.
A national cohort study found that veterans in the most disadvantaged areas had a higher risk of being diagnosed with thicker melanomas, even after adjusting for individual and tumour characteristics. This association persisted even when excluding thinner tumours, reducing the impact of overdiagnosis. These findings highlight how SDOH influence cancer outcomes, even within a healthcare system designed to minimise financial barriers.
ADI evaluates neighbourhood deprivation through employment, education, housing, and poverty. Unlike previous research focusing on individual factors like income and race, ADI provides a broader view of how neighbourhood conditions affect melanoma outcomes. These findings suggest education and income may mediate rather than confound this relationship.
Systemic disadvantages, such as living in deprived neighbourhoods, impact overall health and early cancer detection. Further research is needed to explore the link between adverse neighbourhood conditions and melanoma prognosis.
Historical ADI data over three years showed a consistent association between neighbourhood deprivation and thicker melanoma diagnoses. Despite equal access to VA healthcare, veterans continue to experience disparities influenced by their living environments. Addressing ADI factors through affordable housing, public transport, and stable employment may improve healthcare outcomes and reduce melanoma disparities among veterans.
Katie Wright, EMJ
Reference
Moncayo AK et al. Area deprivation index and melanoma thickness in veterans. JAMA Dermatol. 2025;DOI:10.1001/jamadermatol.2025.0311.
