Journal of surgical oncology · 2025
Disparities in Cutaneous Melanoma Diagnosis and Survival Among American Indian and Alaskan Native Patients: A Systematic Review and Meta-Analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Li Rena A, Nguyen Antoinette T, Bajaj Kethan, Coles Brigid M, Galiano Robert D
Аннотация
BACKGROUNDS AND METHODS: American Indian and Alaska Native (AI/AN) populations face significant health disparities across multiple cancer types, yet melanoma-specific outcomes remain under-investigated. A comprehensive search of Embase, Scopus, and PubMed identified 20 studies meeting inclusion criteria. Three meta-analyses were conducted using random effects models to assess: (1) adjusted hazard ratios for mortality risk, (2) adjusted odds ratios for late-stage diagnosis, and (3) age-adjusted incidence rates.
RESULTS: The meta-analysis revealed significant disparities in melanoma outcomes for AI/AN patients. AI/AN patients demonstrated a 43% higher mortality risk compared to white patients (pooled aHR = 1.43, 95% CI: 1.12-1.82, p = 0.0041) and a 75% higher likelihood of late-stage diagnosis (pooled adjusted OR = 1.75, 95% CI: 1.16-2.65, p = 0.0080). AI/AN patients consistently presented with worse prognostic factors including higher Breslow thickness, increased ulceration rates, and more advanced disease stages.
CONCLUSION: This study provides the first meta-analytic evidence demonstrating statistically significant disparities in melanoma outcomes among AI/AN populations. Systemic barriers include insurance disparities, geographic isolation, treatment delays, and limited access to specialized dermatologic care.
DISCUSSION: These findings justify targeted interventions including enhanced screening programs, improved healthcare infrastructure, and policy reforms to address insurance and access barriers affecting AI/AN communities.
RESULTS: The meta-analysis revealed significant disparities in melanoma outcomes for AI/AN patients. AI/AN patients demonstrated a 43% higher mortality risk compared to white patients (pooled aHR = 1.43, 95% CI: 1.12-1.82, p = 0.0041) and a 75% higher likelihood of late-stage diagnosis (pooled adjusted OR = 1.75, 95% CI: 1.16-2.65, p = 0.0080). AI/AN patients consistently presented with worse prognostic factors including higher Breslow thickness, increased ulceration rates, and more advanced disease stages.
CONCLUSION: This study provides the first meta-analytic evidence demonstrating statistically significant disparities in melanoma outcomes among AI/AN populations. Systemic barriers include insurance disparities, geographic isolation, treatment delays, and limited access to specialized dermatologic care.
DISCUSSION: These findings justify targeted interventions including enhanced screening programs, improved healthcare infrastructure, and policy reforms to address insurance and access barriers affecting AI/AN communities.