# Skin cancer in Germany: Characterising screening, prevalence and mortality from a spatial perspective

## TL;DR

This study explores how skin cancer screening, prevalence, and mortality vary across regions in Germany and identifies sociodemographic factors influencing these patterns.

## Contribution

The study is the first to identify spatial associations between skin cancer screening, prevalence, and mortality in Germany.

## Key findings

- Significant regional variations in skin cancer prevalence, screening, and mortality were found in Germany.
- Lower income and poorer dermatologist accessibility predicted lower screening and prevalence rates.
- Educational status was significantly associated with regions showing low screening and high mortality.

## Abstract

Aim of the study was to characterise the association between screening, prevalence and mortality of skin cancer in Germany considering the spatial distribution. The study included the total set of outpatient data of all statutory health insured people and cause-of-death statistics in Germany between 2011–2015 on county level. To identify regions with high/low screening, prevalence and mortality rates, probability maps were calculated. Scenarios were developed based on the research questions. These were used to identify regions that share both high/low rates of screening, prevalence and mortality. Regression analyses were used to characterise these regions, taking into account sociodemographic characteristics. Significant regional variations in prevalence, screening and mortality in Germany were identified. Depending on the scenario, influences of sociodemographic conditions become apparent. For example, a lower income (p = 0.006) and poorer accessibility of the closest dermatologist (p = 0.03) predicted a lower prevalence of and fewer screenings for skin cancer. In regions with low screening and high mortality, significant (p = 0.03) associations with the educational status of the population were also found. The study identified the first spatial associations between screening, prevalence and mortality of skin cancer in Germany. The results indicate that regional population-related characteristics (e.g., sociodemographic characteristics) play an important role in explaining the associations and should be given more weight in further studies. However, further studies, particularly on the spatial variation of skin cancer mortality, are still necessary.