Trends in melanoma mortality among non-Hispanic whites by educational attainment, 1993-2007.

Objective: To evaluate overall trends in melanoma mortality rates among non-Hispanic whites by educational level.

Methods: Descriptive study. Methods: Death certificate records from 26 states, representing approximately 45% of the US population as reported by the National Center for Health Statistics, with recorded educational level information and population data from the US Bureau of Census Current Population Survey. Methods: Recorded deaths from malignant melanoma in non-Hispanic whites reported from 1993 through 2007. Methods: Age-standardized mortality rates for melanoma were evaluated by educational attainment (a marker of socioeconomic status) among non- Hispanic whites (aged 25-64 years) from 1993 through 2007. Rate ratios assessed the time trend in age-adjusted death rates by sex and educational level. Mortality differentials in educational level were measured using the regression-based Relative Index of Inequality. All statistical tests were 2-sided.

Results: Melanoma mortality declined significantly between 1993-1997 and 2003-2007 in men (RR [rate ratio], 0.916; 95% CI, 0.878-0.954; P.001) and women (RR, 0.907; 95% CI, 0.857-0.957; P.001). However, these declines occurred only among the most educated persons (≥13 years of education irrespective of sex), and nonsignificant increases were found among the least-educated individuals, specifically men (P=.17). As a result, the Relative Index of Inequality by education in melanoma mortality in 2003-2007 relative to 1993-1997 (baseline) widened by 51.7% in men and by 35.7% in women.

Conclusions: Recent declines in melanoma mortality rates among non-Hispanic whites in the United States mainly reflect declines among the most-educated individuals. The widening disparities in melanoma mortality rates by education calls for early detection strategies to effectively target high-risk, less-educated, non-Hispanic white individuals.