Effect of Social Determinants of Health and Geography on Uveal Melanoma

This study aims to examine the geographic distribution of ocular oncologists in the United States and evaluates how social determinants of health (SDOH) and environmental factors influence access to ocular oncologists nationally and uveal melanoma (UM) outcomes locally at the University of Illinois (UI) Hospital.

A national analysis mapped ocular oncologist locations using ArcGIS Pro, assessing accessibility via drive-time radii (15-60 minutes) and census tract population density. SDOH variables (income, education, and insurance) were extracted from US Census data. A retrospective chart review of 167 UM patients at UI Hospital (2010-2023) analyzed tumor characteristics, referral patterns, and SDOH/environmental factors linked to zip codes. Statistical analyses included t-tests, logistic regression, and False Discovery Rate correction.

Nationally, 33.5% of the population, including 45.9% of rural residents, live beyond 60 minutes of an ocular oncologist. Areas outside of an accessible distance of an ocular oncologist were more likely to have low-income, less-educated, and uninsured populations (p < 0.001). At UI Hospital, patients outside a 60-minute radius required significantly more referrals (p = 0.046) but showed no differences in tumor stage at presentation. Trends suggested larger tumor thickness in areas with fewer naturalized citizens and more households under the Asset Limited, Income Constrained, Employed threshold. (q = 0.068 and q = 0.093, respectively). Environmental factors showed no significant associations, including Lifetime Inhalation Cancer Risk, Water Polluting Sites Environmental Justice Index, and Optometrists Per Capita.

There may be geographic and socioeconomic barriers that limit access to UM care, particularly in rural and underserved communities. While proximity did not affect tumor presentation at UI Hospital, referral delays and socioeconomic trends highlight systemic inequities. Multicenter studies are needed to further explore these disparities and improve equitable UM care delivery.