State-level trends and associated disparities in melanoma burden in the United States.

Abstract

1619 Background: Melanoma, an aggressive skin cancer, poses a significant public health challenge in the United States despite advancements in detection and treatment due to its high mortality. This study analyzes trends in melanoma incidence, mortality, and disease burden in the US from 1990 to 2021. Methods: Data on incidence rates (IR), mortality rates (MR), disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs) from 1990 to 2021 were extracted from the Global Burden of Disease 2021 database. Regional trends within the US were evaluated to identify state-level patterns and disparities. Results: In 2021, melanoma IR in the US was 27.2 per 100,000, far exceeding the global average of 3.8. Between 1990 and 2021, IR increased by 64.8%, compared to a global rise of 28.8%. Among US states, Maine had the highest IR at 37.8 per 100,000, while the District of Columbia reported the lowest IR at 8.3. Alaska showed the largest relative increase (EAPC of 81.5%), while New Jersey was the only state to report a decline in incidence, with an EAPC of -1.6%. The US melanoma mortality rate was 3.0 per 100,000 in 2021, compared to the global rate of 0.78. US mortality increased by 5.5%, while the global mortality rate rose by 25.8%. West Virginia recorded the highest mortality rate at 4.49 per 100,000, whereas the District of Columbia had the lowest rate at 1.20 and the most significant improvement, with an EAPC of -43.5%. In terms of DALYs, the US reported a rate of 79.2 per 100,000 in 2021, significantly higher than the global average of 21.27. Between 1990 and 2021, DALYs in the US declined by 14.4%, contrasting with an 8.5% increase globally. The DALY/incidence ratio in 2021 was 2.9 in the US, compared to 5.6 globally, indicating notable differences in disease burden across populations. Melanoma disproportionately affected males, with an IR of 33.9 per 100,000 compared to 20.7 in females (male-to-female ratio: 1.6). Mortality rates followed a similar pattern, with males experiencing a rate of 4.0 per 100,000 vs. 2.1 for females, consistent with global trends. Conclusions: Despite the decrease in DALYs, melanoma incidence and mortality continue to rise in the US, exceeding global averages. Significant disparities persist across states and genders, reflecting the complex interplay of risk factors and behavioral patterns. The lower DALY/incidence ratio in the United States highlights the likely effectiveness of US treatment options in mitigating disease burden per case. Variations among states may also be attributed to differences in ethnic distribution, which influence genetic susceptibility, healthcare access, and prevention efforts.