Who goes to the dermatologist?

Rising Skin Cancer Rates Are More Likely To Affect Wealthy People, Says 12-year Review

I read this article in the Science Daily, and the title and following quote intrigued me.

Women living in affluent areas were 29 per cent more likely than people living in disadvantaged areas to suffer from basal cell carcinoma and nearly two and a half times more likely to suffer from malignant melanoma.

Men displayed a similar pattern. They were 41 per cent more likely to suffer from basal cell carcinoma if they lived in an affluent area and two and a half times more likely to suffer from malignant melanoma.

The article referred to a study published last month.

Hoey et al. Skin cancer trends in Northern Ireland and consequences for provision of dermatology services. British Journal of Dermatology. 156, pp1301-1307. June 2007.

I found these statements particularly interesting as I am currently reviewing data for a local Moh's surgeon, and, as I ran through the data, I wondered about the socioeconomic effects on treating and diagnosing skin cancer. There are a number of day laborers working in industry in this area who are contract employees and likely do not have particularly good health insurance. I'm guessing that, even though they are high-risk for sun damaged skin, going to the dermatologist for yearly skin checks is not high on their priority lists. I wanted to look at the socioeconomic status versus likelihood for multiple lesions or recurrence rates. But this population is so hard to access because they simply do not visit the dermatologist. And, if they do, it is at a late stage, and they are less likely to follow up for regular skin checks, so recurrence rates are difficult to record.

So any study using data from patients who voluntarily went to the dermatologist is naturally skewed towards more affluent patients. Even in Ireland, where the majority of citizens are covered by public or private health insurance, this does not imply equivalent care. There are still both public and private health care options, and I cannot help but assume that public health care options are harder and more expensive to access. Working in a public hospital in the U.S., one realizes how difficult it is to even get an appointment with a specialist such as a dermatologist.

Anyways, my point is that statements like this are very misleading. After reviewing the article, it appears that the researchers divided their already-diagnosed-with-skin-cancer sample population based on their economic districts. Of course there will be fewer people from the poorer neighborhoods. Of course more affluent people have more time and better access to healthcare, causing their increased diagnosis of skin cancer. We need a study comparing incidence rates of skin cancer amongst varying socioeconomic classes. That would be a much better representation of the effect of affluence on skin cancer rates.