Background:

Despite encouraging trends in survival, sociodemographic inequalities persist among patients with melanoma.

Objective:

We sought to quantify the effect of race/ethnicity, socioeconomic status (SES), and healthcare systems on melanoma-specific mortality within an insured population of patients.

Methods:

Using a retrospective cohort study, we identified insured adults diagnosed with Stage I-IV melanoma from 1/1/2009 through 12/31/2014, followed through 2017, from the California Cancer Registry. We compared melanoma-specific mortality between insured patients diagnosed within the largest vertically integrated healthcare system in California, Kaiser Permanente Southern California (KPSC), and insured patients with outside private insurance (OPI).

Results:

Our cohort included 14,614 adults diagnosed with melanoma. Multivariable analyses demonstrated that race/ethnicity was not associated with survival disparities, while SES was a strong predictor of melanoma-specific mortality, particularly for those with OPI. For example, hazard ratios demonstrate that the poorest patients with OPI have a 70% increased risk of dying from their melanoma compared to their wealthiest counterparts, while the poorest patients in KPSC have no increased risk.

Limitations:

Our main limitation includes inadequate data for certain racial/ethnic groups, such as Native Americans.

Conclusions:

Our findings underscore the persistence of socioeconomic disparities within an insured population, specifically among those in non-integrated healthcare systems.