Background/Objectives: Later-stage melanoma at diagnosis is associated with increased mortality. Health care access, socioeconomic status, and neighborhood-level factors likely influence stage at presentation. This study aimed to examine whether neighborhood disadvantage, as measured by the Area Deprivation Index (ADI), is associated with later-stage melanoma diagnosis. Methods: We conducted a cross-sectional analysis of a retrospective cohort of 941 patients diagnosed with melanoma at a large academic medical center between 2010 and 2019. Residential addresses were geocoded and linked to ADI and rurality data. Covariates included race, ethnicity, age, gender, and insurance status. Multivariable logistic regression models with robust standard errors clustered at the census tract level were used to assess associations with melanoma stage at diagnosis. Results: Of 941 patients (63% male, 92.8% non-Hispanic White, mean age 64 years), 432 (46%) were diagnosed with late-stage melanoma. Mean ADI was higher among late-stage cases (5.4) compared to early-stage cases (3.3) (p < 0.001), even after adjustment for covariates. Non-Hispanic White race, private insurance, older age, and urban residences were associated with earlier stage at diagnosis. Racial disparities were attenuated after adjusting for ADI, with no significant interaction between race and ADI. Conclusions: Neighborhood disadvantage is significantly associated with later-stage melanoma diagnosis and contributes to observed racial and socioeconomic disparities. These findings highlight the need for targeted educational interventions and health policy initiatives to reduce late-stage melanoma diagnoses in vulnerable populations.
Cowan et al. (2025) studied this question.