Introduction
Methods
Data sources
CMM cases
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Stage I: all CMMs with a Breslow thickness ≤ 1.0 mm and CMMs with a 1.1–2.0 mm thickness without ulceration (early detection);
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Stage II: CMMs of 1.1–2.0 mm thickness with ulceration and all CMMs > 2.0 mm;
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Stage III-IV (combined due to the rarity of stage IV): CMMs with spreading to regional lymph nodes (III) or with distant metastases (IV).
Small areas and small-area-level data
Stage I CMM cases across age groups and quintiles of small-area deprivation | Stage II CMM cases across age groups and quintiles of small-area deprivation | Stage III–IV CMM cases across age groups and quintiles of small-area deprivation | Statistics based on proportion of cases with stage II–IV tumours (observed proportions and associations with age and small-area deprivation) | Statistics based on proportion of cases with stage III–IV tumours (observed proportions and associations with age and small-area deprivation) | ||||||||
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Number | (%) | Number | (%) | Number | (%) | Proportion | ORa | (95% CI) | Proportion | ORb | (95% CI) | |
Age group (years) | ||||||||||||
30– 34 | 254 | (3.5) | 27 | (1.2) | 16 | (2.2) | 0.14 | 1.0 | Ref. | 0.05 | 1.0 | Ref. |
35–39 | 396 | (5.4) | 43 | (1.9) | 29 | (4.0) | 0.15 | 1.07 | (0.71–1.61) | 0.06 | 1.16 | (0.62–2.17) |
40–44 | 538 | (7.4) | 59 | (2.6) | 36 | (5.0) | 0.15 | 1.05 | (0.71–1.56) | 0.06 | 1.03 | (0.56–1.89) |
45–49 | 599 | (8.2) | 79 | (3.5) | 45 | (6.2) | 0.17 | 1.22 | (0.84–1.78) | 0.06 | 1.14 | (0.63–2.05) |
50–54 | 592 | (8.1) | 108 | (4.8) | 50 | (6.9) | 0.21 | 1.56 | (1.08–2.26) | 0.07 | 1.23 | (0.69–2.20) |
55–59 | 717 | (9.8) | 139 | (6.1) | 82 | (11.3) | 0.24 | 1.77 | (1.24–2.54) | 0.09 | 1.63 | (0.94–2.84) |
60–64 | 818 | (11.2) | 193 | (8.5) | 73 | (10.0) | 0.25 | 1.86 | (1.31–2.65) | 0.07 | 1.17 | (0.67–2.05) |
65–69 | 1009 | (13.8) | 256 | (11.3) | 98 | (13.5) | 0.26 | 1.97 | (1.39–2.78) | 0.07 | 1.26 | (0.73–2.17) |
70–74 | 837 | (11.5) | 298 | (13.1) | 98 | (13.5) | 0.32 | 2.68 | (1.89–3.79) | 0.08 | 1.43 | (0.83–2.47) |
75–79 | 685 | (9.4) | 298 | (13.1) | 90 | (12.4) | 0.36 | 3.15 | (2.22–4.46) | 0.08 | 1.52 | (0.88–2.64) |
80–84 | 472 | (6.5) | 323 | (14.2) | 61 | (8.4) | 0.45 | 4.52 | (3.18–6.42) | 0.07 | 1.28 | (0.73–2.26) |
85–89 | 290 | (4.0) | 270 | (11.9) | 28 | (3.9) | 0.51 | 5.72 | (4.98–8.22) | 0.05 | 0.84 | (0.45–1.58) |
90 + | 95 | (1.3) | 180 | (7.9) | 21 | (2.9) | 0.68 | 11.8 | (7.86–17.7) | 0.07 | 1.21 | (0.61–2.40) |
Total | 7302 | 2273 | 727 | |||||||||
Small-area deprivation within the study region, by median income quintiles (thousands of SEK/year) | ||||||||||||
Q1 (108–189) | 973 | (13.3) | 418 | (18.4) | 110 | (15.1) | 0.35 | 1.40c | (1.21–1.62) | 0.07 | 1.07c | (0.83–1.37) |
Q2 (190–212) | 1362 | (18.7) | 490 | (21.6) | 139 | (19.1) | 0.32 | 1.27c | (1.11–1.45) | 0.07 | 1.00c | (0.79–1.26) |
Q3 (213–230) | 1457 | (20.0) | 469 | (20.6) | 159 | (21.9) | 0.30 | 1.30c | (1.13–1.48) | 0.08 | 1.12c | (0.89–1.39) |
Q4 (231–252) | 1574 | (21.6) | 447 | (19.7) | 140 | (19.3) | 0.27 | 1.15c | (1.00–1.32) | 0.06 | 0.92c | (0.73–1.16) |
Q5 (253–398) | 1936 | (26.5) | 449 | (19.8) | 179 | (24.6) | 0.24 | 1.0 | Ref. | 0.07 | 1.0 | Ref. |
Small-area deprivation within Gothenburg, by median income quintiles (thousands of SEK/year) | ||||||||||||
Q1 (123–179) | 61 | (6) | 41 | (13) | 8 | (11) | 0.45 | 2.95c | (1.85–4.69) | 0.07 | 1.90c | (0.79–4.56) |
Q2 (180–208) | 186 | (18) | 59 | (19) | 17 | (24) | 0.29 | 1.52c | (1.05–2.20) | 0.06 | 1.70c | (0.85–3.39) |
Q3 (209–240) | 192 | (19) | 74 | (24) | 13 | (18) | 0.31 | 1.82c | (1.27–2.61) | 0.05 | 1.17c | (0.56–2.44) |
Q4 (241–272) | 234 | (23) | 61 | (20) | 15 | (21) | 0.25 | 1.23c | (0.85–1.76) | 0.05 | 1.18c | (0.58–2.39) |
Q5 (273–393) | 344 | (34) | 71 | (23) | 18 | (25) | 0.21 | 1.0 | Ref. | 0.04 | 1.0 | Ref. |
Small-area deprivation within Malmoe, by median income quintiles (thousands of SEK/year) | ||||||||||||
Q1 (108–162) | 24 | (6) | 23 | (15) | 7 | (12) | 0.56 | 2.71c | (1.42–5.15) | 0.13 | 1.42c | (0.55–3.70) |
Q2 (163–192) | 67 | (16) | 27 | (18) | 12 | (20) | 0.37 | 1.33c | (0.78–2.25) | 0.11 | 1.30c | (0.59–2.87) |
Q3 (193–217) | 85 | (20) | 29 | (19) | 6 | (10) | 0.29 | 0.90c | (0.54–1.53) | 0.05 | 0.55c | (0.21–1.43) |
Q4 (218–246) | 111 | (26) | 35 | (23) | 15 | (25) | 0.31 | 0.98c | (0.61–1.58) | 0.09 | 1.01c | (0.49–2.09) |
Q5 (247–398) | 134 | (32) | 36 | (24) | 19 | (32) | 0.29 | 1.0 | Ref. | 0.10 | 1.0 | Ref. |
Analysis of proportion of cases with late-stage tumours
Analysis of stage-specific incidences
Overall time-trends
Disease mapping
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PP > 0.90, coloured in red (a strong signal indicating an elevated incidence);
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0.90 ≥ PP > 0.80, coloured in light red (a moderate signal indicating an elevated incidence);
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0.80 ≥ PP > 0.20, coloured in yellow;
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0.20 ≥ PP > 0.10, coloured in light green (a moderate signal indicating a lowered incidence);
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0.10 ≥ PP, coloured in green (a strong signal indicating a lowered incidence).
Sensitivity analyses with conclusions about model choice
Associations with small-area deprivation
Results
Analysis of proportion of cases with late-stage tumours
Analysis of stage-specific incidences
Overall time-trends
Disease mapping
Associations with small-area deprivation
Stage I CMM | Stage II CMM | |||
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Ratio between average-level incidences | (95% CI) | Ratio between average-level incidences | (95% CI) | |
Small-area deprivation (median income) quintiles within the study region | ||||
Q1 | 1.0 | Ref. | 1.0 | Ref. |
Q2 | 1.11 | (1.08–1.15) | 1.01 | (1.00–1.02) |
Q3 | 1.11 | (1.08–1.15) | 1.01 | (0.99–1.02) |
Q4 | 1.18 | (1.14–1.21) | 1.02 | (1.00–1.03) |
Q5 (wealthiest) | 1.35 | (1.31–1.39) | 1.04 | (1.03–1.05) |
Small-area deprivation (median income) quintiles within Gothenburg | ||||
Q1 | 1.0 | Ref. | a | |
Q2 | 1.39 | (1.27–1.53) | a | |
Q3 | 1.43 | (1.31–1.57) | a | |
Q4 | 1.55 | (1.42–1.70) | a | |
Q5 | 1.95 | (1.78–2.13) | a | |
Small-area deprivation (median income) quintiles within Malmoe | ||||
Q1 | 1.0 | Ref. | a | |
Q2 | 1.26 | (1.12–1.43) | a | |
Q3 | 1.45 | (1.28–1.65) | a | |
Q4 | 1.65 | (1.46–1.86) | a | |
Q5 | 2.01 | (1.77–2.27) | a |