Abstract：
BACKGROUND: Previous studies on the associations between socioeconomic status (SES) and cutaneous malignant melanoma (CMM) failed to distinguish the effects of different SES factors under an individual-data-based prospective study design.
METHODS: Based on UK Biobank (UKB) and China Kadoorie Biobank (CKB), we estimated the effects of four SES factors on transitions from baseline to CMM in situ, subsequently to invasive CMM and further CMM mortality by applying multistate models. We further explored to which extent the associations between SES and CMM incidence could be explained by potential mediators including sun exposure, lifestyle and ageing in UKB.
RESULTS: In multistate analyses, good household income was independently associated with an increased risk of CMM in situ (HR=1.38, 95% CI: 1.21 to 1.58) and invasive CMM (HR=1.34, 95% CI: 1.22 to 1.48) in UKB. These findings were partly validated in CKB. Especially in UKB, we observed an increased risk of CMM in situ and invasive CMM among participants with good type of house; only good education was independently associated with lower risk of evolving to invasive CMM among patients with CMM in situ (HR=0.69, 95% CI: 0.52 to 0.92); only good household income was independently associated with lower risk of CMM mortality among patients with CMM (HR=0.65, 95% CI: 0.45 to 0.95). In mediation analysis, the proportions attributable to the mediating effect were <6% for all selected variables, including self-reported sun exposure-related factors.
CONCLUSIONS: SES factors have different effects on the incidence and progression of CMM. The association between SES and incident CMM is neither causal nor well explained by selected mediators.
METHODS: Based on UK Biobank (UKB) and China Kadoorie Biobank (CKB), we estimated the effects of four SES factors on transitions from baseline to CMM in situ, subsequently to invasive CMM and further CMM mortality by applying multistate models. We further explored to which extent the associations between SES and CMM incidence could be explained by potential mediators including sun exposure, lifestyle and ageing in UKB.
RESULTS: In multistate analyses, good household income was independently associated with an increased risk of CMM in situ (HR=1.38, 95% CI: 1.21 to 1.58) and invasive CMM (HR=1.34, 95% CI: 1.22 to 1.48) in UKB. These findings were partly validated in CKB. Especially in UKB, we observed an increased risk of CMM in situ and invasive CMM among participants with good type of house; only good education was independently associated with lower risk of evolving to invasive CMM among patients with CMM in situ (HR=0.69, 95% CI: 0.52 to 0.92); only good household income was independently associated with lower risk of CMM mortality among patients with CMM (HR=0.65, 95% CI: 0.45 to 0.95). In mediation analysis, the proportions attributable to the mediating effect were <6% for all selected variables, including self-reported sun exposure-related factors.
CONCLUSIONS: SES factors have different effects on the incidence and progression of CMM. The association between SES and incident CMM is neither causal nor well explained by selected mediators.
摘要：
背景：先前关于社会经济地位（SES）与皮肤恶性黑色素瘤（CMM）之间关联的研究未能在基于个体数据的前瞻性研究设计中区分不同SES因素的影响。
方法：基于英国生物样本库（UKB）和中国嘉道理生物样本库（CKB），我们估计了四个SES因素对从基线到原位坐标测量机转变的影响，随后通过应用多态模型进行侵入性CMM和进一步的CMM死亡率。我们进一步探讨了SES和CMM发病率之间的关联在多大程度上可以通过潜在的介质来解释，包括阳光照射，UKB中的生活方式和衰老。
结果：在多状态分析中，良好的家庭收入与UKB中原位CMM(HR=1.38,95%CI:1.21~1.58)和侵入性CMM(HR=1.34,95%CI:1.22~1.48)的风险增加独立相关.这些发现在CKB中得到了部分验证。尤其是在UKB,我们观察到,在房屋类型良好的参与者中,CMM原位和侵入性CMM的风险增加;在CMM原位患者中,只有良好的教育与发展为侵入性CMM的风险较低独立相关(HR=0.69,95%CI:0.52~0.92);在CMM患者中,只有良好的家庭收入与CMM死亡率风险较低独立相关(HR=0.65,95%CI:0.45~0.95).在调解分析中，所有选定变量的中介效应所占比例均<6%，包括自我报告的阳光照射相关因素。
结论：SES因素对CMM的发生和进展有不同的影响。SES和事件CMM之间的关联既不是因果关系，也不是由选定的调解员很好地解释的。
方法：基于英国生物样本库（UKB）和中国嘉道理生物样本库（CKB），我们估计了四个SES因素对从基线到原位坐标测量机转变的影响，随后通过应用多态模型进行侵入性CMM和进一步的CMM死亡率。我们进一步探讨了SES和CMM发病率之间的关联在多大程度上可以通过潜在的介质来解释，包括阳光照射，UKB中的生活方式和衰老。
结果：在多状态分析中，良好的家庭收入与UKB中原位CMM(HR=1.38,95%CI:1.21~1.58)和侵入性CMM(HR=1.34,95%CI:1.22~1.48)的风险增加独立相关.这些发现在CKB中得到了部分验证。尤其是在UKB,我们观察到,在房屋类型良好的参与者中,CMM原位和侵入性CMM的风险增加;在CMM原位患者中,只有良好的教育与发展为侵入性CMM的风险较低独立相关(HR=0.69,95%CI:0.52~0.92);在CMM患者中,只有良好的家庭收入与CMM死亡率风险较低独立相关(HR=0.65,95%CI:0.45~0.95).在调解分析中，所有选定变量的中介效应所占比例均<6%，包括自我报告的阳光照射相关因素。
结论：SES因素对CMM的发生和进展有不同的影响。SES和事件CMM之间的关联既不是因果关系，也不是由选定的调解员很好地解释的。
