Abstract
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. To measure the burden of skin diseases worldwide. 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. 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 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. Disability-adjusted life years (DALYs), years lived with disability, and years of life lost from 15 skin conditions in 188 countries. 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. 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 leading cause of disability worldwide.
Highlights
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
Skin conditions contributed 1.79% to the global burden of disease measured in Disability-adjusted life years (DALYs) from 306 diseases and injuries in 2013
Skin and subcutaneous diseases were responsible for 41.6 million DALYs and 39.0 million years lived with disability (YLDs) in 2013
Summary
The following skin conditions were selected based on available data, standardized disease definitions, and prevalence: dermatitis (including the common varieties of eczema: atopic, seborrheic, and contact dermatitis), psoriasis, cellulitis, pyoderma, scabies, fungal skin diseases, viral skin diseases, acne vulgaris, alopecia areata, pruritus, urticaria, decubitus ulcer, malignant skin melanoma, and keratinocyte carcinoma (including basal and squamous cell carcinomas). “other skin and subcutaneous diseases,” encompasses the remainder of miscellaneous skin conditions.[5] International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes were used to define each of the 15 skin disease categories (eTable 1 in the Supplement). The initial step in the GBD estimation strategy was a thorough investigation of the world literature using PubMed and Google Scholar for data on the incidence, prevalence, remission, duration, severity, and mortality risk (only applicable for selected skin diseases) of the 15 skin conditions. Most incidence data for certain skin diseases were obtained from 3
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