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Original Investigation
June 10, 2020

The Burden of Skin and Subcutaneous Diseases in the United States From 1990 to 2017

Author Affiliations
  • 1Department of Dermatology, University of Colorado School of Medicine, Denver
  • 2Department of Dermatology, University of California San Francisco, San Francisco
  • 3Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts
  • 4School of Health Sciences, Kristiania University College, Oslo, Norway
  • 5Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana
  • 6Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
  • 7Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
  • 8Usher Institute, The University of Edinburgh, Edinburgh, Scotland
  • 9Medicine Service, Veterans Affairs Medical Center, Birmingham, Alabama
  • 10Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham
  • 11Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham
  • 12Kobe University Graduate School of Medicine, Division of Dermatology, Department of Internal Related, Kobe, Japan
  • 13Gene Expression and Regulation Program, The Wistar Institute, Philadelphia, Pennsylvania
  • 14Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
  • 15Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
  • 16Kaiser Permanente, Ontario, California
  • 17College of Medicine, University of Central Florida, Orlando
  • 18Institute of Health Metrics and Evaluation, University of Washington, Seattle
JAMA Dermatol. 2020;156(8):874-881. doi:10.1001/jamadermatol.2020.1573
Key Points

Question  Has the burden of skin and subcutaneous diseases varied across the US from 1990 to 2017?

Findings  This cohort study of patients included in the Global Burden of Disease database from 1990 to 2017 evaluated skin and subcutaneous disease burden across the US, the disability-adjusted life-year rate, incidence, and prevalence of skin disease increased from 1990 to 2017, and disease burden varied by geographic location. The highest age-standardized disability-adjusted life-year rate was found in New York, whereas Wyoming had the lowest rate.

Meaning  These epidemiological national data on disease burden can guide future research efforts, allocation of resources, prevention strategies, and targeted treatment of skin conditions.


Importance  Skin and subcutaneous diseases affect the health of millions of individuals in the US. Data are needed that highlight the geographic trends and variations of skin disease burden across the country to guide health care decision-making.

Objective  To characterize trends and variations in the burden of skin and subcutaneous tissue diseases across the US from 1990 to 2017.

Design, Setting, and Participants  For this cohort study, data were obtained from the Global Burden of Disease (GBD), a study with an online database that incorporates current and previous epidemiological studies of disease burden, and from GBD 2017, which includes more than 90 000 data sources such as systematic reviews, surveys, population-based disease registries, hospital inpatient and outpatient data, cohort studies, and autopsy data. The GBD separated skin conditions into 15 subcategories according to incidence, prevalence, adequacy of data, and standardized disease definitions. GBD 2017 also estimated the burden from melanoma of the skin and keratinocyte carcinoma. Data analysis for the present study was conducted from September 9, 2019, to March 31, 2020.

Main Outcomes and Measures  Primary study outcomes included age-standardized disability-adjusted life-years (DALYs), incidence, and prevalence. The data were stratified by US states with the highest and lowest age-standardized DALY rate per 100 000 people, incidence, and prevalence of each skin condition. The percentage change in DALY rates in each state was calculated from 1990 to 2017.

Results  Overall, age-standardized DALY rates for skin and subcutaneous diseases increased from 1990 (821.6; 95% uncertainty interval [UI], 570.3-1124.9) to 2017 (884.2; 95% UI, 614.0-1207.9) in all 50 states and the District of Columbia. The degree of increase varied according to geographic location, with the largest percentage change of 0.12% (95% UI, 0.09%-0.15%) in New York and the smallest percentage change of 0.04% (95% UI, 0.02%-0.07%) in Colorado, 0.04% (95% UI, 0.01%-0.06%) in Nevada, 0.04% (95% UI, 0.02%-0.07%) in New Mexico, and 0.04% (95% UI, 0.02%-0.07%) in Utah. The age-standardized DALY rate, incidence, and prevalence of specific skin conditions differed among the states. New York had the highest age-standardized DALY rate for skin and subcutaneous disease in 2017 (1097.0 [95% UI, 764.9-1496.1]), whereas Wyoming had the lowest age-standardized DALY rate (672.9 [95% UI, 465.6-922.3]). In all 50 states and the District of Columbia, women had higher age-standardized DALY rates for overall skin and subcutaneous diseases than men (women: 971.20 [95% UI, 676.76-1334.59] vs men: 799.23 [95% UI, 559.62-1091.50]). However, men had higher DALY rates than women for malignant melanoma (men: 80.82 [95% UI, 51.68-123.18] vs women: 42.74 [95% UI, 34.05-70.66]) and keratinocyte carcinomas (men: 37.56 [95% UI, 29.35-49.52] vs women: 14.42 [95% UI, 10.01-20.66]).

Conclusions and Relevance  Data from the GBD suggest that the burden of skin and subcutaneous disease was large and that DALY rate trends varied across the US; the age-standardized DALY rate for keratinocyte carcinoma appeared greater in men. These findings can be used by states to target interventions and meet the needs of their population.

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