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Number of county-wide dermatologists associated with lower mortality rates for melanoma

Aneja S. Arch Dermatol. 2012;148:174-178.

A greater density of dermatologists meant that patients were more likely to survive melanoma, according to a database analysis of 2,472 counties in the United States.

The total population in those counties was more than 226 million. Rural counties were excluded from the analysis. Melanoma mortality and incidence rate were reported as age-adjusted mean rates per 100,000 people from 2002 to 2006.

The researchers said there are no dermatologists in much of the country, particularly in the central United States. Density was greatest in clusters on the Eastern Seaboard and in the Midwest, along the Pacific Coast and in Hawaii.

The absolute melanoma mortality rate was 1.45 (95% CI, 0.71-2.18) based on an incidence of 19 diagnoses per 100,000 people in the reference group. The presence of 0.001 to one dermatologist per 100,000 people was associated with a –0.51 absolute reduction in mortality. The presence of one to two dermatologists was associated with a –0.77 absolute reduction in melanoma mortality, and two to four dermatologists was associated with a –0.56 absolute reduction. The absolute reduction in melanoma mortality was –0.66 with four or more dermatologists.

Researchers concluded that the presence of 0.001 to one dermatologist per 100,000 people was associated with a 35% reduction in mortality (95% CI, 13.4-56.6). Density of more than one to two dermatologists per 100,000 people was associated with a 53% reduction in melanoma mortality (95% CI, 30.6-75.4). There was no additional mortality benefit observed when there were two or more dermatologists per 100,000 people.

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