Low rate of dermatology outpatient visits in Asian-Americans: an initial survey study for associated patient-related factors
Tóm tắt
Asian-Americans represent the fastest growing minority group in the United States, but are under-represented patients in outpatient dermatology clinics. At the same time, skin cancer rates in individuals of Asian descent are increasing, but skin cancer detection appears to be delayed in Asian-Americans compared to white individuals. Some health-care provider related factors for this phenomenon have been reported in the literature, but the patient-related factors are unclear. This exploratory study to identify patient-related factors associated with dermatology visits in Asian-Americans was performed after Institutional Review Board (IRB) approval. An anonymous, online survey utilizing validated items was conducted on adults who self-identified as Asian-American in Northern California. Univariate and multivariate logistic regression for dermatology visits as indicated by responses to the question of “ever having had skin checked by a dermatologist” were performed on survey responses pertaining to demographic information, socioeconomic factors, acculturation, knowledge of melanoma warning signs and SSE belief and practice. 89.7% of individuals who opened the online survey completed the items, with 469 surveys included in the analysis. Only 60% reported ever performing a SSE, and only 48% reported ever having a skin examination by a dermatologist. Multivariate models showed that “ever performing SSE” (p < 0.0001), marital status (p = 0.02), family history of skin cancer (p = 0.03) and generation in the United States (p = 0.02) were significant predictors of the primary outcome of “ever had skin checked by a dermatologist”. Identification of patient-related factors that associate with dermatology clinic visits in Asian-Americans is important so that this potential gap in dermatologic care can be better addressed through future studies.
Tài liệu tham khảo
US Census Bureau Population Division: Projections of the resident population by race, Hispanic origin, and nativity: middle series, 1999–2100. Washington (DC): US Census Bureau; 2000.
Wu XC, Eide MJ, King J, Saraiya M, Huan Y, Wiggins C, Barnholtz-Sloan JS, Martin N, Cokkinides V, Miller J, Patel P, Ekwueme DU, Kim J: Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999–2006. J Am Acad Dermatol 2011, 65: S26-S37. 10.1016/j.jaad.2010.12.028
Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M, Roberts WE, Draelos ZD, Bhushan R, Taylor SC, Lim HW: Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol 2014, 70(4):748–762. 10.1016/j.jaad.2013.11.038
Ishihara K, Saida T, Yamamoto A: Updated statistical data for malignant melanoma in Japan. Int J Clin Oncol 2001, 6(3):109–116.
Koh D, Wang H, Lee J, Chia KS, Lee HP, Goh CL: Basal cell carcinoma, squamous cell carcinoma and melanoma of the skin: analysis of the Singapore Cancer Registry data 1968–97. Br J Dermatol 2003, 148(6):1161–1166. 10.1046/j.1365-2133.2003.05223.x
Sng J, Koh D, Siong WC, Choo TB: Skin cancer trends among Asians living in Singapore from 1968 to 2006. J Am Acad Dermatol 2009, 61(3):426–432. 10.1016/j.jaad.2009.03.031
Chen YJ, Wu CY, Chen JT, Shen JL, Chen CC, Wang HC: Clinicopathologic analysis of malignant melanoma in Taiwan. J Am Acad Dermatol 1999, 41(6):945–949. 10.1016/S0190-9622(99)70251-3
Cress RD, Holly EA: Incidence of cutaneous melanoma among non-Hispanic whites, Hispanics, Asians, and blacks: an analysis of california cancer registry data, 1988–93. Cancer Causes Control 1997, 8(2):246–252. 10.1023/A:1018432632528
Johnson DS, Yamane S, Morita S, Yonehara C, Wong JH: Malignant melanoma in non-Caucasians: experience from Hawaii. Surg Clin North Am 2003, 83(2):275–282. 10.1016/S0039-6109(02)00093-2
Coups EJ, Stapleton JL, Hudson SV, Medina-Forrester A, Rosenberg SA, Gordon M, Natale-Pereira A, Goydos JS: Skin cancer surveillance behaviors among US Hispanic adults. J Am Acad Dermatol 2013, 68(4):576–584. 10.1016/j.jaad.2012.09.032
Kasparian NA, Bränström R, Chang YM, Affleck P, Aspinwall LG, Tibben A, Azizi E, Baron-Epel O, Battistuzzi L, Bruno W, Chan M, Cuellar F, Debniak T, Pjanova D, Ertmanski S, Figl A, Gonzalez M, Hayward NK, Hocevar M, Kanetsky PA, Leachman S, Bergman W, Heisele O, Palmer J, Peric B, Puig S, Schadendorf D, Gruis NA, Newton-Bishop J, Brandberg Y, Melanoma Genetics Consortium (GenoMEL): Skin examination behavior: the role of melanoma history, skin type, psychosocial factors and region of residence in determining clinical and self-conducted skin examination. Arch Dermatol 2012, 148(10):1142–1151. 10.1001/archdermatol.2012.1817
Emmons KM, Geller AC, Puleo E, Savadatti SS, Hu SW, Gorham S, Werchniak AE: Skin cancer education and early detection at the beach: a randomized trial of dermatologist examination and biometric feedback. J Am Acad Dermatol 2011, 64(2):282–289. 10.1016/j.jaad.2010.01.040
Aitken JF, Janda M, Elwood M, Youl PH, Ring IT, Lowe JB: Clinical outcomes from skin screening clinics within a community-based melanoma screening program. J Am Acad Dermatol 2006, 54(1):105–114. 10.1016/j.jaad.2005.08.072
Hamidi R, Peng D, Cockburn M: Efficacy of skin self-examination for the early detection of melanoma. Int J Dermatol 2010, 49(2):126–134.
Berwick M, Begg CB, Fine JA, Roush GC, Barnhill RL: Screening for cutaneous melanoma by skin self-examination. J Natl Cancer Inst 1996, 88(1):17–23. 10.1093/jnci/88.1.17
Pollitt RA, Geller AC, Brooks DR, Johnson TM, Park ER, Swetter SM: Efficacy of skin self-examination practices for early melanoma detection. Cancer Epidemiol Biomarkers Prev 2009, 18(11):3018–3023. 10.1158/1055-9965.EPI-09-0310
Brady MS, Oliveria SA, Christos PJ, Berwick M, Coit DG, Katz J, Halpern AC: Patterns of detection in patients with cutaneous melanoma. Cancer 2000, 89(2):342–347. 10.1002/1097-0142(20000715)89:2<342::AID-CNCR19>3.0.CO;2-P
United States Preventative Services Task Force 2009 guidelines for skin self-examination and population based screening in asymptomatic persons by primary care physicians at, accessed May 20, 2014 http://www.uspreventiveservicestaskforce.org/uspstf09/skincancer/skincanrs.htm
Gorell E, Lee C, Munoz C, Chang AL: Adoption of Western culture by Californian Asian Americans: attitudes and practices promoting sun exposure. Arch Dermatol 2009, 145(5):552–556.
Suinn RM, Ahuna C, Khoo G: The Suinn-Lew Asian Self-Identity Acculturation Scale: Concurrent and Factorial Validation. Educ Psychol Meas 1992, 52(4):1041–1046. 10.1177/0013164492052004028
Lee S, Chen L, He X, Miller MJ, Juon HS: A cluster analytic examination of acculturation and health status among Asian Americans in the Washington DC metropolitan area, United States. Soc Sci Med 2013, 96: 17–23.
Lee S, Chen L, Jung MY, Baezconde-Garbanati L, Juon HS: Acculturation and cancer screening among Asian Americans: role of health insurance and having a regular physician. J Community Health 2014, 39(2):201–212. 10.1007/s10900-013-9763-0
Weinstock MA, Martin RA, Risica PM, Berwick M, Lasater T, Rakowski W, Goldstein MG, Dube CE: Thorough skin examination for the early detection of melanoma. Am J Prev Med 1999, 17(3):169–175. 10.1016/S0749-3797(99)00077-X
Hamidi R, Cockburn MG, Peng DH: Prevalence and predictors of skin self-examination: prospects for melanoma prevention and early detection. Int J Dermatol 2008, 47(10):993–1003.
Coups EJ, Geller AC, Weinstock MA, Heckman CJ, Manne SL: Prevalence and correlates of skin cancer screening among middle-aged and older white adults in the United States. Am J Med 2010, 123(5):439–445. 10.1016/j.amjmed.2009.10.014
Mitchell J, Leslie KS: Melanoma death prevention: moving away from the sun. J Am Acad Dermatol 2013, 68(6):169–175. 10.1016/j.jaad.2012.09.028
The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-5945/14/13/prepub