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What is the burden of skin disease worldwide?
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.
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.
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 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.
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 leading cause of disability worldwide.
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Corresponding Author: Chante Karimkhani, MD, University Hospitals Case Western Medical Center, 408 W St Clair Ave, Unit 317, Cleveland, OH 44113 (email@example.com).
Accepted for Publication: November 19, 2016.
Correction: This article was corrected on May 10, 2017, to add the Open Access paragraph to the acknowledgments section. This article was corrected online March 29, 2017, to fix errors in the Key Points and the Abstract.
Published Online: March 1, 2017. doi:10.1001/jamadermatol.2016.5538
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2017 Karimkhani C et al. JAMA Dermatology.
Author Contributions: Drs Karimkhani and Naghavi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Coffeng, Hay, Vos, Naghavi.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Karimkhani, Nsoesie, Erskine.
Critical revision of the manuscript for important intellectual content: Karimkhani, Dellavalle, Coffeng, Flohr, Hay, Langan, Nsoesie, Ferrari, Silverberg, Vos, Naghavi.
Statistical analysis: Karimkhani, Coffeng, Ferrari, Erskine, Silverberg, Vos, Naghavi.
Administrative, technical, or material support: Karimkhani, Naghavi.
Supervision: Vos, Dellavalle, Coffeng, Hay, Langan, Vos, Naghavi.
Conflict of Interest Disclosures: Drs Coffeng, Nsoesie, Ferrari, Erskine, Vos, and Naghavi are or have been employed by the Institute for Health Metrics and Evaluation during the time of study. Drs Karimkhani, Dellavalle, Hay, Langan, and Silverberg are GBD collaborators without funding. Dr Dellavalle is an employee of the US Department of Veterans Affairs. Dr Langan is supported by a National Institute for Health Research Clinician Scientist award from the United Kingdom Department of Health. Drs Ferrari and Erskine are affiliated with the Queensland Centre for Mental Health research, which receives funding from the Queensland Department of Health. No other disclosures are reported.
Funding/Support: This study was supported in part by the Bill and Melinda Gates Foundation (principal investigator: Christopher J. L. Murray).
Role of the Funder/Sponsor: The Bill and Melinda Gates Foundation had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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