Demographic Disparities in Melanoma of Skin-related Mortality and Trends in the United States Between 1999 and 2020: A CDC Population-Based Analysis

Importance Existing literature provides only sparse data concerning US death trends for skin melanoma. Objective To evaluate the trends in skin melanoma-related mortality in the United States. Design, Setting, and Participants A retrospective cohort study was conducted using mortality statistics spanning from January 1999 to December 2020 from the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) database. The data included all US age cohorts where cutaneous melanoma was recorded as an underlying or contributing cause of death. Statistical review was performed in March 2024. Exposure All age groups with skin melanoma recorded as a contributing and underlying cause of mortality. Main Outcomes and Measures Primary outcomes were the Age-Adjusted Mortality Rates (AAMR) for cutaneous melanoma per 100,000 US citizens, differentiated by sex, race/ethnicity, and geographical region Results Between 1999 and 2020, a total of 184,416 melanoma-related deaths occurred in all age groups. Of these, 119,557 (64.8%) were men and 64,859 (35.16%) were women, and 2,756 (1.5%) were Black, 18,262 (97.7%) were White, 352 (0.19%) were Alaskan Indian or American Native, and 1,046 (0.56%) were Asian or Pacific Islanders. The overall AAMR during the study duration was 2.52; AAMR was higher for men compared with women (2.52 vs. 1.6) and higher for white adults compared with non-Hispanic and Black adults (2.89 vs. 2.69 vs. 0.38, respectively). Across most demographic and regional subgroups, AAMR increased in non-metropolitan areas from 2.86 in 1999 to 3.04 in 2007 and then decreased from 2008 to 2020. There were significant regional differences in the burden of melanoma-related mortality, with states in the upper 90th percentile (such as Utah, Idaho, Wyoming, Oklahoma, and West Virginia) having a higher burden than those in the lower 90th percentile. Conclusion and Relevance The skin melanoma-related mortality rate decreased among all age groups between 1999 and 2020. White adults had a 0.2- and 2.51-fold increase in AAMR from 1999 to 2009 compared with non-Hispanic and Black adults, respectively, and then it decreased for all races from 2009 onwards. Specific health policy interventions are necessary to assess the growing death rate from cutaneous melanoma across all age ranges. Public health approaches, driven by data, must prioritize prevention, early detection, effective treatment, and equitable reduction of disparities.