You are here

  • Home
  • Online First
  • Socioeconomic disparity in the natural history of cutaneous melanoma: evidence from two large prospective cohorts

Article Text

Article menu
Download PDFPDF
Original research
Socioeconomic disparity in the natural history of cutaneous melanoma: evidence from two large prospective cohorts
  1. Songchun Yang1,2,3,4,
  2. Yi Xiao1,2,3,4,
  3. Danrong Jing1,2,3,4,
  4. Hong Liu1,2,3,4,
  5. Juan Su1,2,3,4,
  6. Minxue Shen1,2,3,4,5,
  7. Xiang Chen1,2,3,4
  1. 1Department of Dermatology | Hunan Engineering Research Center of Skin Health and Disease | Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China
  2. 2National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Central South University, Changsha, Hunan, China
  3. 3National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
  4. 4Furong Laboratory, Changsha, Hunan, China
  5. 5Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
  1. Correspondence to Professor Minxue Shen, Department of Dermatology | Hunan Engineering Research Center of Skin Health and Disease | Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; shenmx1988{at}csu.edu.cn; Professor Juan Su, Department of Dermatology | Hunan Engineering Research Center of Skin Health and Disease | Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; sujuanderm{at}csu.edu.cn; Professor Xiang Chen, Department of Dermatology | Hunan Engineering Research Center of Skin Health and Disease | Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China; chenxiangck{at}csu.edu.cn

Abstract

Background Previous studies on the associations between socioeconomic status (SES) and cutaneous malignant melanoma (CMM) failed to distinguish the effects of different SES factors under an individual-data-based prospective study design.

Methods Based on UK Biobank (UKB) and China Kadoorie Biobank (CKB), we estimated the effects of four SES factors on transitions from baseline to CMM in situ, subsequently to invasive CMM and further CMM mortality by applying multistate models. We further explored to which extent the associations between SES and CMM incidence could be explained by potential mediators including sun exposure, lifestyle and ageing in UKB.

Results In multistate analyses, good household income was independently associated with an increased risk of CMM in situ (HR=1.38, 95% CI: 1.21 to 1.58) and invasive CMM (HR=1.34, 95% CI: 1.22 to 1.48) in UKB. These findings were partly validated in CKB. Especially in UKB, we observed an increased risk of CMM in situ and invasive CMM among participants with good type of house; only good education was independently associated with lower risk of evolving to invasive CMM among patients with CMM in situ (HR=0.69, 95% CI: 0.52 to 0.92); only good household income was independently associated with lower risk of CMM mortality among patients with CMM (HR=0.65, 95% CI: 0.45 to 0.95). In mediation analysis, the proportions attributable to the mediating effect were <6% for all selected variables, including self-reported sun exposure-related factors.

Conclusion SES factors have different effects on the incidence and progression of CMM. The association between SES and incident CMM is neither causal nor well explained by selected mediators.

  • MELANOMA
  • EDUCATION
  • ECONOMICS
  • Health inequalities

Data availability statement

Data are available upon reasonable request. This work has been conducted using the UK Biobank Resource (Application Number: 55257). The UK Biobank is an open-access resource, and bona fide researchers can apply to use the UK Biobank dataset by registering and applying at http://ukbiobank.ac.uk/register-apply/. This research has been conducted using the CKB resource (Request No. DAR-2023-00149). Details of how to access CKB data and details of the data release schedule are available from www.ckbiobank.org/data-access. Further information is available from the corresponding author upon request.

https://doi.org/10.1136/jech-2024-222158

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available upon reasonable request. This work has been conducted using the UK Biobank Resource (Application Number: 55257). The UK Biobank is an open-access resource, and bona fide researchers can apply to use the UK Biobank dataset by registering and applying at http://ukbiobank.ac.uk/register-apply/. This research has been conducted using the CKB resource (Request No. DAR-2023-00149). Details of how to access CKB data and details of the data release schedule are available from www.ckbiobank.org/data-access. Further information is available from the corresponding author upon request.

    View Full Text

    Footnotes

    • JS, MS and XC contributed equally.

    • Contributors MS (lead) and XC (supporting) contributed to conceptualisation. MS (lead) and XC (supporting) contributed to data curation. SY (lead), XY (supporting) and DJ (supporting) contributed to formal analysis. XC (lead) and MS (supporting) contributed to funding acquisition. SY (lead), XY (supporting) and DJ (supporting) contributed to investigation. MS (lead) and SY (supporting) contributed to methodology. XC (lead) and MS (supporting) contributed to project administration. MS (lead) and HL (supporting) contributed to resources. XC (lead), MS (supporting) and JS (supporting) contributed to supervision. MS (lead) and HL (supporting) contributed to validation. SY (lead), YX (supporting) and DJ (supporting) contributed to visualisation. SY (lead), MS (supporting) and JS (supporting) contributed to writing, original draft preparation. MS (lead), XC (supporting) and JS (supporting) contributed to review and editing. MS is the guarantor.

    • Funding This work was supported by National Key Research and Development Program of China (2022YFC2504700). MS was supported by Huxiang Youth Talent Program (2022RC1014). Funding for the development of and maintenance of the CKB resource has been received from Chinese Ministry of Science and Technology, Chinese National Natural Science Foundation, the Kadoorie Charitable Foundation in Hong Kong and the Wellcome Trust. These funders have not supported the research work required for the preparation of this paper.

    • Competing interests The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest. This research has been conducted using the China Kadoorie Biobank (CKB) resource (www.ckbiobank.org, Request No. DAR-2023-00149). Publication of results does not require or imply approval by the membership of the CKB Collaborative Group.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.