Developing indices to identify hotspots of skin cancer vulnerability among the Non-Hispanic White population in the United States.


Skin cancer is the most common, yet oftentimes preventable, cancer type in the United States. Exposure to ultraviolet (UV) radiation from sunlight is the most prominent environmental risk factor for skin cancer. Besides environmental exposure, demographic characteristics such as race, age, and socioeconomic (SES) status may make some groups more vulnerable. Based on county-level UV data and demographic risk factors, two vulnerability indices for skin cancer were generated using an additive percentile rank approach. With these indices, univariate local Moran's I spatial autocorrelation identified significant clusters, or hotspots, of neighboring counties with high overall vulnerability indices. Clusters were identified separately for skin cancer incidence and mortality. Counties with high vulnerabilities were spatially distributed across the United States in a pattern that generally increased to the South and West. Clusters of counties with high skin cancer incidence vulnerability were mostly observed in Utah and Colorado, even with highly conservative levels of significance. Meanwhile, clusters for skin cancer mortality vulnerability were observed in southern Alabama and west Florida as well as across north Alabama, north Georgia and up through the Tennessee-North Carolina area. These highly vulnerable counties where environmental and demographic risk factors significantly overlap could be prioritized for preventive interventions, emphasizing local need based on unique underlying spatial patterns of risk for each skin cancer outcome.

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