The Influence of Marital Status on Stage at Diagnosis and Survival of Older Persons With Melanoma

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Abstract
Background. Melanoma incidence and mortality had a sustained increase in the last 3 decades in the United States, especially among white older men. Little is known about the relationship between marital status and melanoma outcomes in older people. The objective of this study was to determine the association between marital status and stage at diagnosis and survival of older persons with cutaneous melanoma. Methods. Data are from the Surveillance, Epidemiology and End Results (SEER) registries–Medicare–linked database (1991–1999). The sample consisted of 14,630 men and women 65 years old and older. The outcomes were melanoma stage at diagnosis and melanoma specific survival. The main independent variable, marital status, was used in four categories: married, single, separated or divorced, and widowed. Other covariates include sociodemographics, stage at diagnosis, tumor characteristics (body site and histology), and comorbidity index. Logistic regression and survival analyses techniques were used. Results. Multivariate analyses showed that, compared with married persons, widowed persons were more likely to be diagnosed with late-stage (regional or distant) versus early-stage (in situ or localized) melanoma (odds ratio = 1.31, 95% confidence interval [CI], 1.13–1.52). In addition, after controlling for all other variables (sociodemographics, stage at diagnosis, tumor characteristics, and comorbidity), widowed persons were at increased risk of death from melanoma (hazard ratio = 1.23, 95% CI, 1.06–1.44). Conclusion. Older widowed persons were more likely to be diagnosed at late stage and to die from melanoma than were older married persons.