Impact of Social Determinants on Melanoma Outcomes in Canada: A Single-Centre Retrospective Study.

Abstract

Introduction: Socioeconomic status (SES) and distance to nearest hospital are known social determinants impacting melanoma survival; however, few studies have investigated the effect in a universal healthcare setting, like Canada.

Materials and methods: This retrospective study at The Ottawa Hospital (1999-2023) investigated SES and distance lived from the hospital on overall survival, recurrence time, and stage at presentation in melanoma surgical patients. Income quintiles (InQs) were determined using postal codes linked to 2016 census data, and logistic regressions were conducted for the highest and lowest InQs.

Results: Of 959 patients, 277 were in the highest InQ group (mean age: 64; 57% males) and 114 were in the lowest (mean age: 60; 48% males). Higher InQ was significantly associated with lower odds of stage II-IV disease at presentation (p = 0.004, odds ratio: 0.865, 95% CI 0.784 to 0.954), but not with overall survival, recurrence time, or stage III-IV disease. Distance had no significant impact on outcomes. Female sex was protective against recurrence time (p = 0.020, hazard ratio: 0.705), stage II-IV (p = 0.049, odds ratio: 0.766, 95% CI: 0.587, 0.999), and III-IV (p = 0.009, odds ratio: 0.670, 95% CI: 0.496, 0.904) disease.

Conclusion: Higher SES reduced stage II-IV risk without affecting survival, stage III-IV risk, or recurrence time. Distance to nearest hospital had no significant effect. Females had longer time to recurrence and lower odds of advanced disease. Future research should explore potential educational and primary care barriers that may contribute to advanced stages in lower InQ populations.