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Original Investigation
March 1, 2017

Global Skin Disease Morbidity and MortalityAn Update From the Global Burden of Disease Study 2013

Author Affiliations
  • 1University Hospitals Case Western Medical Center, Cleveland, Ohio
  • 2now with Department of Dermatology, University of Colorado, Denver
  • 3Dermatology Service, US Department of Veterans Affairs, Eastern Colorado Health Care System, Denver
  • 4University of Colorado School of Medicine, Aurora
  • 5Colorado School of Public Health, Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora
  • 6Institute for Health Metrics and Evaluation, University of Washington, Seattle
  • 7Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
  • 8Unit for Population-Based Dermatology Research, St John’s Institute of Dermatology, Guy’s & St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom
  • 9Department of Dermatology, Kings College NHS Trust, London, United Kingdom
  • 10Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • 11School of Public Health, University of Queensland, Herston, Queensland, Australia
  • 12Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
  • 13Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 14Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 15Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Dermatol. Published online March 1, 2017. doi:10.1001/jamadermatol.2016.5538
Key Points

Question  What is the burden of skin disease worldwide?

Findings  In this observational study, skin diseases contributed 1.79% to the global burden of disease measured in disability-adjusted life years (DALYs). Skin diseases arranged in order of decreasing global DALYs are as follows: dermatitis (atopic, contact, seborrheic), acne vulgaris, urticaria, psoriasis, viral skin diseases, fungal skin diseases, scabies, melanoma, pyoderma, cellulitis, keratinocyte carcinoma, decubitus ulcer, and alopecia areata.

Meaning  Skin diseases remain a major cause of disability worldwide. An objective measure of burden, such as the DALY, allows for comparison of diverse diseases across geography and time.

Abstract

Importance  Disability secondary to skin conditions is substantial worldwide. The Global Burden of Disease Study 2013 includes estimates of global morbidity and mortality due to skin diseases.

Objective  To measure the burden of skin diseases worldwide.

Data Sources  For nonfatal estimates, data were found by literature search using PubMed and Google Scholar in English and Spanish for years 1980 through 2013 and by accessing administrative data on hospital inpatient and outpatient episodes. Data for fatal estimates were based on vital registration and verbal autopsy data.

Study Selection  Skin disease data were extracted from more than 4000 sources including systematic reviews, surveys, population-based disease registries, hospital inpatient data, outpatient data, cohort studies, and autopsy data. Data metrics included incidence, prevalence, remission, duration, severity, deaths, and mortality risk.

Data Extraction and Synthesis  Data were extracted by age, time period, case definitions, and other study characteristics. Data points were modeled with Bayesian meta-regression to generate estimates of morbidity and mortality metrics for skin diseases. All estimates were made with 95% uncertainty intervals.

Main Outcomes and Measures  Disability-adjusted life years (DALYs), years lived with disability, and years of life lost from 15 skin conditions in 188 countries.

Results  Skin conditions contributed 1.79% to the global burden of disease measured in DALYs from 306 diseases and injuries in 2013. Individual skin diseases varied in size from 0.38% of total burden for dermatitis (atopic, contact, and seborrheic dermatitis), 0.29% for acne vulgaris, 0.19% for psoriasis, 0.19% for urticaria, 0.16% for viral skin diseases, 0.15% for fungal skin diseases, 0.07% for scabies, 0.06% for malignant skin melanoma, 0.05% for pyoderma, 0.04% for cellulitis, 0.03% for keratinocyte carcinoma, 0.03% for decubitus ulcer, and 0.01% for alopecia areata. All other skin and subcutaneous diseases composed 0.12% of total DALYs.

Conclusions and Relevance  Skin and subcutaneous diseases were the 18th leading cause of global DALYs in Global Burden of Disease 2013. Excluding mortality, skin diseases were the fourth largest cause of disability worldwide.

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