SOCIOECONOMIC CHARACTERISTICS AND MELANOMA INCIDENCE

PURPOSE: This investigation examines the relationship between socioeco nomic status (SES) and melanoma incidence in counties included in the Surveillance, Epidemiology, and End Results Registry (SEER) in the Uni ted States from 1973 to 1993. METHODS: Cases included whites, aged at least 15 years, with a morphologic diagnosis of malignant melanoma, re siding in one of 199 counties at the time of diagnosis. County level m easures of SES including median household income, percentage of high s chool graduates, and percentage of families below poverty were abstrac ted from the 1950, 1960, 1970, 1980, and 1990 U.S. Census data. The re lationship between SES factors and melanoma rates was examined by hier archical Poisson regression. RESULTS: The percentage of high school gr aduates was significantly and positively associated with the incidence of melanoma (relative risk (RR), 1.28; 95% confidence interval (CI), 1.21-1.35), after controlling for age at diagnosis, gender, time perio d, latitude, and percentage of Hispanics in the county. Percentage of families below poverty was significantly inversely associated with the incidence of melanoma (RR, 0.66; 95% CI, 0.55-0.78). When education a nd poverty were included in the same model, both the positive effects of education (RR, 1.23; 95% CI, 1.16-1.31) and the negative effects of poverty (RR, 0.85; 95% CI, 0.74-0.98) persisted. In contrast, median household income was not associated with melanoma incidence in a simil ar multivariable model (RR, 1.00; 95% CI, 0.99-1.00). CONCLUSION: Whet her the effect of education on incidence of melanoma reflects lifestyl e behaviors that modify exposure to sunlight or some other factor rema ins unclear. Nonetheless, the findings of this study suggest that the determinant is primarily related to education, not income. (C) 1998 El sevier Science Inc.