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Tran MM, Orsillo L, Wei G, Mirza FN, Yumeen S, Wisco OJ. Applications and Best Practices for Geospatial Analysis Research in Dermatology. J Invest Dermatol 2024; 144:738-747. [PMID: 38519249 DOI: 10.1016/j.jid.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/02/2024] [Accepted: 01/23/2024] [Indexed: 03/24/2024]
Abstract
Dermatologic diseases often exhibit distinct geographic patterns, underscoring the significant role of regional environmental, genetic, and sociocultural factors in driving their prevalence and manifestations. Geographic information and geospatial analysis enable researchers to investigate the spatial distribution of adverse health outcomes and their relationship with socioeconomic and environmental risk factors that are inherently geographic. Health geographers and spatial epidemiologists have developed numerous geospatial analytical tools to collect, process, visualize, and analyze geographic data. These tools help provide vital spatial context to the comprehension of the underlying dynamics behind health outcomes. By identifying areas with high rates of dermatologic disease and areas with barriers to access to quality dermatologic care, findings from studies utilizing geospatial analysis can inform the design and targeting of policy and intervention to help improve dermatologic healthcare outcomes and promote health equity. This article emphasizes the significance of geospatial data and analysis in dermatology research. We explore the common processes in data acquisition, harmonization, and geospatial analytics while conducting spatially and dermatologically relevant research. The article also highlights the practical application of geospatial analysis through instances drawn from the dermatology literature.
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Affiliation(s)
- Megan M Tran
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
| | | | - Guixing Wei
- Spatial Structures in the Social Sciences, Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
| | - Fatima N Mirza
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Sara Yumeen
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Oliver J Wisco
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Roberson L, Ugwu-Dike P, Stevenson PA, Collier SM. Geographic access to dermatologic care in urban underserved communities. J Am Acad Dermatol 2024; 90:410-412. [PMID: 37816411 PMCID: PMC11019860 DOI: 10.1016/j.jaad.2023.09.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 08/14/2023] [Accepted: 09/17/2023] [Indexed: 10/12/2023]
Affiliation(s)
| | | | - Philip A Stevenson
- Clinical Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Sigrid M Collier
- Department of Dermatology, University of Washington, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
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Ahmed F, Lim R, Moseley I, Hoang M, Wisco O, Robinson-Bostom L, Qureshi A, Cho E. Neighborhood-Level Socioeconomic Predictors of Melanoma Thickness, Ulceration, and Metastasis at a Rhode Island Academic Center. J Invest Dermatol 2023; 143:2541-2546.e2. [PMID: 37406960 DOI: 10.1016/j.jid.2023.06.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/09/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Fadwa Ahmed
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rachel Lim
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Isabelle Moseley
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Megan Hoang
- Brown University, Providence, Rhode Island, USA
| | - Oliver Wisco
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Leslie Robinson-Bostom
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Abrar Qureshi
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Epidemiology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Eunyoung Cho
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Department of Epidemiology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Mesia RJ, Espinosa PR, Hutchison H, Safaeinili N, Finster LJ, Muralidharan V, Glenn BA, Haile RW, Rosas LG, Swetter SM. Melanoma awareness and prevention among latinx and non-latinx white adults in urban and rural California: A qualitative exploration. Cancer Med 2022; 12:7438-7449. [PMID: 36433634 PMCID: PMC10067099 DOI: 10.1002/cam4.5457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 09/26/2022] [Accepted: 11/09/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Melanoma mortality rates in the US are highest among older men, individuals of lower socioeconomic status (SES), and people of color. To better understand these inequities, a qualitative exploratory study was conducted in Northern and Southern California to generate knowledge about barriers and facilitators of awareness, prevention, and early detection of melanoma in lower SES Latinx and non-Latinx White (NLW) individuals living in urban and semi-rural areas. METHODS Nineteen focus groups were conducted (N = 176 adult participants), stratified by race/ethnicity (Latinx, low-income NLW), geography (semi-rural, urban), and language (English and Spanish). Inductive and deductive thematic analysis was conducted, and the findings were organized using the socioecological model framework: individual, interpersonal, community, and health system/policy levels. RESULTS Four socioecological themes describe how key factors affect knowledge, perceived risk, preventive behaviors, and melanoma screening. Individual level findings revealed that many participants were not familiar with melanoma, yet were willing to learn through trusted sources. Having brown or darker skin tone was perceived as being associated with lower risk for skin cancer. Interpersonally, social relationships were important influences for skin cancer prevention practice. However, for several Latinx and semi-rural participants, conversations about melanoma prevention did not occur with family and peers. At the community level, semi-rural participants reported distance or lack of transportation to a clinic as challenges for accessing dermatology care. Healthcare systems barriers included burdens of additional healthcare costs for dermatology visits and obtaining referral. CONCLUSIONS Varying factors influence the awareness levels, beliefs, and behaviors associated with knowledge, prevention, and early detection of melanoma among low-income Latinx and NLW individuals and in semi-rural areas. Results have implications for health education interventions. Navigation strategies that target individuals, families, and health care settings can promote improved prevention and early detection of melanoma in these communities.
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Affiliation(s)
- Rachel J Mesia
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | | | - Hayden Hutchison
- Cancer Research Center for Health Equity, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Nadia Safaeinili
- Stanford University School of Medicine, Office of Community Engagement, Stanford, California, USA
| | - Laurel J Finster
- Cancer Research Center for Health Equity, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Vijaytha Muralidharan
- Department of Dermatology/Cutaneous Oncology, Stanford University Medical Center, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Dermatology Service, Palo Alto, California, USA
| | - Beth A Glenn
- UCLA Fielding School of Public Health, UCLA Kaiser Permanente Center for Health Equity, Los Angeles, California, USA
| | - Robert W Haile
- Cancer Research Center for Health Equity, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Lisa Goldman Rosas
- Stanford University School of Medicine, Office of Community Engagement, Stanford, California, USA
| | - Susan M Swetter
- Department of Dermatology/Cutaneous Oncology, Stanford University Medical Center, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Dermatology Service, Palo Alto, California, USA
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Cortez JL, Fadadu RP, Konda S, Grimes B, Wei ML. Disparities in access for melanoma screening by region, specialty, and insurance: A cross-sectional audit study. JAAD Int 2022; 7:78-85. [PMID: 35373156 PMCID: PMC8968658 DOI: 10.1016/j.jdin.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Early detection of melanoma is critical for positive outcomes. However, access for the diagnosis of melanoma remains problematic for segments of the general population. Objective To compare the rates of dermatology and family medicine practitioner acceptances for a public insurance (Medicaid) versus private insurance (Anthem Blue Cross) and clinic wait times for an appointment for a changing pigmented skin lesion concerning melanoma in rural and urban regions in California. Methods Cross-sectional audit study between June 2017 and March 2019; scripted phone calls were made to dermatology and family medicine practices (FMPs). Results Family medicine and dermatology practices in both regions had significantly decreased acceptance of Medicaid. Dermatology practices had 11.3% to 13.0% Medicaid acceptance rates that were less than FMP rates of 28% to 36%. In both regions, FMP wait times were 2.4- to 3.2-fold longer for public versus private insurance; there were little differences in wait times for the 2 insurance types in dermatology practices, in both regions. Limitations Assessment of only 2 regions in the state of California. Conclusion Delays at FMPs and insurance types limit access to melanoma screening in California for underserved segments of the general population, which has implications for melanoma outcomes and health policy.
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Affiliation(s)
- Jose Luis Cortez
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico.,Department of Dermatology, University of California, San Francisco, California.,Dermatology Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Raj P Fadadu
- Department of Dermatology, University of California, San Francisco, California.,Dermatology Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Sailesh Konda
- Department of Dermatology, University of Florida, Gainesville, Florida
| | - Barbara Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Maria L Wei
- Department of Dermatology, University of California, San Francisco, California.,Dermatology Service, San Francisco Veterans Affairs Health Care System, San Francisco, California.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
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Zakhem GA, Pulavarty AN, Lester JC, Stevenson ML. Skin Cancer in People of Color: A Systematic Review. Am J Clin Dermatol 2022; 23:137-151. [PMID: 34902111 DOI: 10.1007/s40257-021-00662-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND People of African, Asian, Hispanic or Latino, Pacific Islander, and Native Indian descent are considered people of color by the Skin of Color Society (SOCS). OBJECTIVES In this study, we assess incidence, risk factors, clinical characteristics, histopathology, treatment, and survival for skin malignancies in people of color as defined by the SOCS, by systematically reviewing the literature. METHODS An electronic literature search of the PubMed, EMBASE, and MEDLINE databases was performed. Articles published from 1 January 1990 through 12 December 2020 were included in the search. RESULTS We identified 2666 publications potentially meeting the study criteria. Titles and abstracts of these studies were reviewed and 2353 were excluded. The full text of 313 articles were evaluated and 251 were included in this review. CONCLUSION Differences in incidence, patterns, treatment, and survival exist among people of color for cutaneous malignancies. Further research and initiatives are needed to account for and mitigate these differences.
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Affiliation(s)
- George A Zakhem
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA
| | - Akshay N Pulavarty
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA
| | - Jenna C Lester
- University of California San Francisco, San Francisco, CA, USA
| | - Mary L Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA.
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Etiologies of Melanoma Development and Prevention Measures: A Review of the Current Evidence. Cancers (Basel) 2021; 13:cancers13194914. [PMID: 34638397 PMCID: PMC8508267 DOI: 10.3390/cancers13194914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Melanoma constitutes a major public health risk, with the rates of diagnosis increasing on a yearly basis. Monitoring for risk factors and preventing dangerous behaviors that increase melanoma risk, such as tanning, are important measures for melanoma prevention. Additionally, assessing the effectiveness of various methods to prevent sun exposure and sunburns—which can lead to melanoma—is important to help identify ways to reduce the development of melanoma. We summarize the recent evidence regarding the heritable and behavioral risks underlying melanoma, as well as the current methods used to reduce the risk of developing melanoma and to improve the diagnosis of this disease. Abstract (1) Melanoma is the most aggressive dermatologic malignancy, with an estimated 106,110 new cases to be diagnosed in 2021. The annual incidence rates continue to climb, which underscores the critical importance of improving the methods to prevent this disease. The interventions to assist with melanoma prevention vary and typically include measures such as UV avoidance and the use of protective clothing, sunscreen, and other chemopreventive agents. However, the evidence is mixed surrounding the use of these and other interventions. This review discusses the heritable etiologies underlying melanoma development before delving into the data surrounding the preventive methods highlighted above. (2) A comprehensive literature review was performed to identify the clinical trials, observational studies, and meta-analyses pertinent to melanoma prevention and incidence. Online resources were queried to identify epidemiologic and clinical trial information. (3) Evidence exists to support population-wide screening programs, the proper use of sunscreen, and community-targeted measures in the prevention of melanoma. Clinical evidence for the majority of the proposed preventive chemotherapeutics is presently minimal but continues to evolve. (4) Further study of these chemotherapeutics, as well as improvement of techniques in artificial intelligence and imaging techniques for melanoma screening, is warranted for continued improvement of melanoma prevention.
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Cortez JL, Vasquez J, Wei ML. The impact of demographics, socioeconomics, and health care access on melanoma outcomes. J Am Acad Dermatol 2020; 84:1677-1683. [PMID: 32783908 DOI: 10.1016/j.jaad.2020.07.125] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022]
Abstract
Disparities in melanoma care exist in the United States. Disparities in provider type, patient demographics, place of residence, insurance status, socioeconomic status, race/ethnicity, and age impact melanoma outcomes. Melanomas detected by dermatologists are thinner, at an earlier stage, and have better survival outcomes compared with detection by primary care providers or patients. Lower socioeconomic status, race/ethnicity, and place of residence are associated with decreased access to or use of dermatologists, or both, and more advanced melanomas at diagnosis. Additionally, uninsured and publicly insured individuals are more likely to present with late-stage melanomas, resulting in worse outcomes. This review provides a comprehensive overview of how structural and patient-level characteristics influence melanoma outcomes in order to inform clinical care and health care policy as it relates to addressing gaps in melanoma care.
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Affiliation(s)
- Jose L Cortez
- Department of Dermatology, University of California, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Juan Vasquez
- Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Maria L Wei
- Department of Dermatology, University of California, San Francisco, California; Dermatology Service, San Francisco Veterans Affairs Medical Center, San Francisco, California; University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
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