FIGURE 2: Age-Adjusted Melanoma Mortality Rates in MS, 1999 – 2023
5
Age-Adjusted Mortality Rate Per 100,000
4
3
2
Female- 1 Joinpoint 1999.0-2020.0 APC =-1.65*
Male- 1 Joinpoint 1999.0-2007.0 APC = 3.82 * 2007.0-2020.0 APC =-2.20*
Overall- 1 Joinpoint 1999.0-2015.0 APC =-0.40 2015.0-2020.0 APC =-6.18*
1 1998
2000
2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 Year
Annual age-adjusted mortality rates( per 100,000 population) for melanoma in MS over a 21-year period. Rates are standardized to the 2000 US population and include data for the total population, with separate trend lines for males and females.
Group
TABLE 2: Annual percent change( APC), Lower confidence limit( LCL), and Upper confidence limit( UCL)
Segment Start
Segment End
These national improvements are likely related to the introduction and growing use of immune checkpoint inhibitors, which began transforming melanoma treatment in the early 2010s. 2 These systemic therapies, including CTLA-4 and PD-1 inhibitors, have significantly improved survival in advanced melanoma and reduced mortality even in regions with limited access to specialized oncology care. 2 During this same period, the routine use of dermoscopy also became more prevalent in clinical practice which
APC APC 95 % LCL
APC 95 % UCL
P-Value
Overall 2015 2020-6.1752-16.1622-1.4926 0.003199
Male 2007 2020-2.2008-5.4507-0.8738 0.001600 Female 1999 2020-1.6495-2.5195-0.7429 < 0.000001
Joinpoint regression analysis of melanoma mortality trends in MS, stratified by sex and time interval, with APC and statistical significance.
has enhanced diagnostic accuracy and earlier detection of melanoma. 1
Despite the overall decline, there is a consistent disparity in melanoma mortality rates between males and females. Males had a higher age-adjusted mortality throughout the study period in both WV and MS. This observation is consistent with broader research indicating men are less likely to engage in preventive dermatologic care and participate in public screening programs, potentially leading to later-stage
diagnoses and poorer outcomes. 3 Factors such as occupational sun exposure and differences in health-seeking behaviors may also contribute to this disparity. 4
While this study did not directly assess the impact of rurality on melanoma mortality within WV, existing literature suggests rural populations may face challenges in cancer care. Studies have indicated patients residing in rural areas are less likely to receive recommended surgical treatments and may experience shorter melanoma-specific survival times. 5 These disparities are often attributed to factors such as limited access to specialized care, longer travel distances to healthcare facilities, and socioeconomic barriers. 5 However, these findings may not be applicable across all rural settings, and further research is needed to understand the specific dynamics within WV and other rural states. Additionally, the expansion of Medicaid in WV under the Affordable Care Act in 2014 may have helped improve access to care during the later years of the study
14 • www. wvsma. org