| Characteristics | Unadjusted Model | Multivariable Model 1† | Multivariable Model 2‡ |
|---|---|---|---|
| Prior physician visits | |||
| Neither PCP nor dermatologist | 1.00 (referent) | 1.00 (referent) | 1.00 (referent) |
| PCP only | 0.82 (0.73–0.93) | 0.84 (0.74–0.95) | 0.87 (0.77–0.99) |
| Dermatologist only | 0.69 (0.55–0.86) | 0.79 (0.63–1.00) | 0.80 (0.64–1.01) |
| Both PCP and dermatologist | 0.59 (0.51–0.67) | 0.66 (0.57–0.76) | 0.72 (0.62–0.83) |
| Age at diagnosis (years) | |||
| 67–75 | 1.00 (referent) | 1.00 (referent) | 1.00 (referent) |
| 76–85 | 1.29 (1.17–1.42) | 1.21 (1.10–1.33) | 1.08 (0.98–1.19) |
| ≥86 | 1.94 (1.71–2.21) | 1.76 (1.53–2.02) | 1.38 (1.20–1.59) |
| Sex | |||
| Male | 1.00 (referent) | 1.00 (referent) | 1.00 (referent) |
| Female | 0.79 (0.72–0.87) | 0.71 (0.65–0.79) | 0.70 (0.63–0.77) |
| Race/ethnicity | |||
| Non-Hispanic white | 1.00 (referent) | 1.00 (referent) | 1.00 (referent) |
| Non-Hispanic black | 2.33 (1.59–3.41) | 1.22 (0.82–1.82) | 1.11 (0.75–1.65) |
| Hispanic | 1.67 (1.26–2.20) | 1.21 (0.91–1.62) | 1.01 (0.76–1.35) |
| Asian/American Indian/Pacific Islander | 1.71 (1.09–2.69) | 1.53 (0.95–2.44) | 1.37 (0.85–2.20) |
| Other | 0.11 (0.05–0.24) | 0.16 (0.07–0.36) | 0.22 (0.10–0.49) |
| Marital status | |||
| Married | 1.00 (referent) | 1.00 (referent) | 1.00 (referent) |
| Never married | 1.51 (1.29–1.77) | 1.33 (1.13–1.56) | 1.31 (1.11–1.54) |
| Separated/divorced | 1.22 (0.98–1.51) | 1.25 (1.00–1.55) | 1.21 (0.97–1.51) |
| Widowed | 1.45 (1.31–1.61) | 1.30 (1.16–1.46) | 1.24 (1.10–1.39) |
| Unknown | 0.36 (0.30–0.42) | 0.40 (0.34–0.47) | 0.55 (0.46–0.65) |
| Education level of residence | |||
| Quintile 1 (lowest) | 1.00 (referent) | 1.00 (referent) | 1.00 (referent) |
| Quintile 2 | 0.79 (0.70–0.90) | 0.93 (0.81–1.07) | 0.96 (0.83–1.11) |
| Quintile 3 | 0.85 (0.75–0.97) | 0.91 (0.78–1.06) | 0.97 (0.83–1.13) |
| Quintile 4 | 0.79 (0.69–0.90) | 0.98 (0.83–1.16) | 1.00 (0.85–1.18) |
| Quintile 5 (highest) | 0.69 (0.60–0.79) | 0.91 (0.75–1.12) | 1.00 (0.82–1.23) |
| Median income of residence | |||
| Quintile 1 (lowest) | 1.00 (referent) | 1.00 (referent) | 1.00 (referent) |
| Quintile 2 | 0.87 (0.76–0.99) | 0.91 (0.79–1.04) | 0.94 (0.81–1.08) |
| Quintile 3 | 0.91 (0.80–1.03) | 0.97 (0.83–1.14) | 1.03 (0.88–1.21) |
| Quintile 4 | 0.91 (0.80–1.04) | 1.04 (0.87–1.23) | 1.10 (0.93–1.30) |
| Quintile 5 (highest) | 0.69 (0.60–0.79) | 0.86 (0.70–1.07) | 0.90 (0.73–1.11) |
| MSA residence | |||
| Large metropolitan | 1.00 (referent) | 1.00 (referent) | 1.00 (referent) |
| Metropolitan | 1.09 (0.99–1.21) | 0.99 (0.87–1.13) | 1.01 (0.88–1.15) |
| Urban | 1.18 (0.98–−1.40) | 1.15 (0.93–1.42) | 1.14 (0.93–1.41) |
| Less urban | 1.18 (1.00–1.39) | 1.13 (0.91–1.40) | 1.09 (0.88–1.36) |
| Rural | 0.88 (0.61–1.25) | 0.78 (0.53–1.16) | 0.83 (0.56–1.23) |
| Year of diagnosis | |||
| 1994–1997 | 1.00 (referent) | 1.00 (referent) | 1.00 (referent) |
| 1998–2000 | 0.90 (0.80–1.02) | 0.86 (0.76–0.98) | 0.93 (0.81–1.05) |
| 2001–2005 | 0.94 (0.84–1.05) | 0.85 (0.75–0.97) | 0.90 (0.79–1.03) |
| Histology type | |||
| Melanoma, NOS | 1.00 (referent) | 1.00 (referent) | 1.00 (referent) |
| Nodular melanoma | 1.74 (1.55–1.95) | 1.90 (1.68–2.14) | 1.14 (1.00–1.29) |
| Superficial spreading | 0.35 (0.31–0.40) | 0.51 (0.44–0.59) | 0.72 (0.63–0.83) |
| Lentigo maligna | 0.14 (0.10–0.19) | 0.21 (0.16–0.28) | 0.39 (0.29–0.53) |
| Acral melanoma | 1.11 (0.82–1.50) | 1.05 (0.77–1.44) | 0.93 (0.68–1.27) |
| Other | 0.98 (0.83–1.16) | 1.05 (0.88–1.25) | 0.76 (0.64–0.91) |
| Stage at diagnosis§ | |||
| Local, thin | 1.00 (referent) | 1.00 (referent) | |
| Local, intermediate | 3.00 (2.43–3.70) | 2.70 (2.18–3.35) | |
| Local, thick | 8.62 (7.11–10.45) | 6.65 (5.43–8.14) | |
| Regional/distant | 26.82 (22.81–31.55) | 16.48 (13.79–19.70) | |
| Unknown | 12.68 (10.31–15.60) | 6.03 (4.81–7.56) | |
| Charlson Comorbidity Index | |||
| 0 | 1.00 (referent) | 1.00 (referent) | 1.00 (referent) |
| 1 | 1.20 (1.08–1.34) | 1.15 (1.03–1.28) | 1.18 (1.06–1.31) |
| 2+ | 1.48 (1.32–1.66) | 1.42 (1.26–1.61) | 1.29 (1.15–1.45) |
| Influenza vaccination | |||
| No | 1.00 (referent) | 1.00 (referent) | 1.00 (referent) |
| Yes | 0.79 (0.72–0.86) | 0.91 (0.83–0.99) | 0.97 (0.89–1.07) |
| Surgery | |||
| Surgery without wide margin | 1.00 (referent) | 1.00 (referent) | 1.00 (referent) |
| Surgery with wide margin | 0.95 (0.85–1.05) | 0.75 (0.67–0.83) | 0.75 (0.67–0.84) |
| No/unknown surgery | 6.52 (5.79–7.35) | 4.50 (3.94–5.13) | 2.51 (2.19–2.88) |
| Lymph node removal | |||
| No/unknown | 1.00 (referent) | 1.00 (referent) | 1.00 (referent) |
| Yes | 1.42 (1.28–1.56) | 1.31 (1.18–1.45) | 0.78 (0.70–0.87) |
| Radiation therapy | |||
| No/unknown | 1.00 (referent) | 1.00 (referent) | 1.00 (referent) |
| Yes | 10.12 (8.88–11.54) | 3.65 (3.15–4.22) | 2.16 (1.87–2.50) |
↵* After excluding people with in situ lesions but including those with unknown stage. Mortality refers to melanoma specific mortality, not all-cause mortality.
↵† Model 1 adjusted for all factors shown in table plus Surveillance Epidemiology and End Results registry but did not adjust for stage at diagnosis.
↵‡ Model 2 further adjusted model 1 for stage at diagnosis.
↵§ Thin lesions are defined as Breslow thickness <1 mm, intermediate are 1 to 2 mm, and thick are >2 mm.
MSA, metropolitan statistical area; NOS, not otherwise specified; PCP, primary care physician.