Association of Income with Enucleation Likelihood and Survival in Uveal Melanoma

Prior research has demonstrated that lower socio-economic status is associated with inferior cancer survival. Little is known about the associations between income and treatment choice or survival in uveal melanoma (UM). We investigate the effects of county-level income on enucleation likelihood and survival in uveal melanoma.

A total of 9,897 UM cases diagnosed between 1990-2021 were selected utilizing International Classification of Diseases for Oncology (ICD-O-3) codes for melanoma (ICD-O-3 8720-8790) and primary site codes C69.3 (choroid) and C69.4 (ciliary body/iris). Cases were categorized by county-level median household income (at least/below $80,000). Overall and UM-specific mortality hazard ratios (HRs) and enucleation odds ratios (ORs) were assessed. Fine-Gray competing risks regression was performed to account for death from other causes. This study used de-identified, publicly available data and is exempt from Institutional Review Board approval.

A total of 9,897 patients were analyzed. The median survival time was 11.9 years (95% CI: 11.3-12.4 years). Multivariable regression shows lower-income patients were 66% more likely to undergo enucleation as primary ocular treatment (aOR = 1.66, 95% CI: 1.49-1.84). County-level income was not associated with worse overall survival. Modest inverse associations with UM-specific mortality were observed in competing risks analyses, likely reflecting higher competing mortality from non-cancer causes among lower-income patients.

Compared with patients from higher-income counties, those from lower-income counties were more likely to undergo primary enucleation and experienced a minimal reduction in UM-specific mortality. Overall survival did not differ. These findings reflect area-level socioeconomic differences.