Stitzenberg KB, Thomas NE, Dalton K, Brier SE, Ollila DW, Berwick M, Mattingly D, Millikan RC. Distance to diagnosing provider as a measure of access for patients with melanoma.
ACTA ACUST UNITED AC 2007;
143:991-8. [PMID:
17709657 PMCID:
PMC3629703 DOI:
10.1001/archderm.143.8.991]
[Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE
To examine the effect of travel distance and other sociodemographic factors on access to a diagnosing provider for patients with melanoma.
DESIGN
Analysis was performed of all incident cases of melanoma in 2000 from 42 North Carolina counties.
SETTING
Academic research.
PARTICIPANTS
Patients and providers from 42 North Carolina counties were geocoded to street address.
MAIN OUTCOME MEASURES
Associations between Breslow thickness and clinical and sociodemographic factors (age, sex, poverty rate, rurality, provider supply, and distance to diagnosing provider) were examined.
RESULTS
Of 643 eligible cases, 4.4% were excluded because of missing data. The median Breslow thickness was 0.6 mm (range, 0.1-20.0 mm). The median distance to diagnosing provider was 8 miles (range, 0-386 miles). For each 1-mile increase in distance, Breslow thickness increased by 0.6% (P =.003). For each 1% increase in poverty rate, Breslow thickness increased by 1% (P =.04). Breslow thickness was 19% greater for patients aged 51 to 80 years than for those aged 0 to 50 years (P =.02) and was 109% greater for patients older than 80 years than for those aged 0 to 50 years (P < .001). Sex, rurality, and supply of dermatologists were not associated with Breslow thickness.
CONCLUSIONS
For patients with melanoma, distance to the diagnosing provider is a meaningful measure of access that captures different information than community-level measures of rurality, provider supply, and socioeconomic status. Future work should be targeted at identifying factors that may affect distance to diagnosing provider and serve as barriers to melanoma care.
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