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

Educational Objective
To learn which skin diseases cause the most morbidity and mortality globally.
1 Credit CME
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 leading cause of disability worldwide.

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Article Information

Corresponding Author: Chante Karimkhani, MD, University Hospitals Case Western Medical Center, 408 W St Clair Ave, Unit 317, Cleveland, OH 44113 (ck2525@caa.columbia.edu).

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.

References
1.
Murray  CJ, Lopez  AD.  Measuring the global burden of disease.  N Engl J Med. 2013;369(5):448-457.PubMedGoogle ScholarCrossref
2.
Murray  CJ, Ezzati  M, Flaxman  AD,  et al.  GBD 2010: design, definitions, and metrics.  Lancet. 2012;380(9859):2063-2066.PubMedGoogle ScholarCrossref
3.
Murray  CJ, Vos  T, Lozano  R,  et al.  Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 [published correction appears in Lancet. 2013;381(9867):628].  Lancet. 2012;380(9859):2197-2223.PubMedGoogle ScholarCrossref
4.
Institute for Health Metrics and Evaluation.  The Global Burden of Disease: Generating Evidence, Guiding Policy. Seattle, WA: Institute for Health Metrics and Evaluation; 2013.
5.
Hay  RJ, Johns  NE, Williams  HC,  et al.  The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions.  J Invest Dermatol. 2014;134(6):1527-1534.PubMedGoogle ScholarCrossref
6.
Global Burden of Disease Study 2013 Collaborators.  Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.  Lancet. 2015;386(9995):743-800.Google ScholarCrossref
7.
Neal  RD, Cannings-John  R, Hood  K,  et al.  Excision of malignant melanomas in North Wales: effect of location and surgeon on time to diagnosis and quality of excision.  Fam Pract. 2008;25(4):221-227.PubMedGoogle ScholarCrossref
8.
Nolan  RC, Chan  MT, Heenan  PJ.  A clinicopathologic review of lethal nonmelanoma skin cancers in Western Australia.  J Am Acad Dermatol. 2005;52(1):101-108.PubMedGoogle ScholarCrossref
9.
National Cancer Institute. SEER cancer statistics review 1975-2013. https://seer.cancer.gov/csr/1975_2013/. Accessed May 16, 2016.
10.
Salomon  JA, Haagsma  JA, Davis  A,  et al.  Disability weights for the global burden of disease 2013 study.  Lancet Glob Health. 2015;3(11):e712-e723.PubMedGoogle ScholarCrossref
11.
GBD 2013 Mortality and Causes of Death Collaborators.  Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.  Lancet. 2015;385(9963):117-171.PubMedGoogle ScholarCrossref
12.
United Nations. World population prospects: 2015 revision. http://esa.un.org/unpd/wpp/publications/files/key_findings_wpp_2015.pdf. Accessed February 17, 2016.
13.
GBD Compare. https://vizhub.healthdata.org/gbd-compare/. Accessed April 1, 2016.
14.
Global Burden of Disease Study 2013 Collaborators.  Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.  Lancet. 2015;386(9995):743-800.PubMedGoogle ScholarCrossref
15.
Murray  CJ, Barber  RM, Foreman  KJ,  et al; GBD 2013 DALYs and HALE Collaborators.  Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition.  Lancet. 2015;386(10009):2145-2191.PubMedGoogle ScholarCrossref
16.
Institute for Health Metrics and Evaluation (IHME).  Financing Global Health 2015: Development Assistance Steady on the Path to New Global Goals. Seattle, WA: IHME; 2016.
17.
International Federation of Dermatology Clinical Trials Networks. About the Federation. http://www.ifdctn.org/about-the-federation/about.aspx. Accessed January 26, 2017.
18.
Robson  KJ, Piette  WW.  Cutaneous manifestations of systemic diseases.  Med Clin North Am. 1998;82(6):1359-1379.PubMedGoogle ScholarCrossref
19.
Hay  RJ, Augustin  M, Griffiths  CE, Sterry  W; Board of the International League of Dermatological Societies and the Grand Challenges Consultation groups.  The global challenge for skin health.  Br J Dermatol. 2015;172(6):1469-1472.PubMedGoogle ScholarCrossref
20.
Freeman  EE.  A seat at the big table: expanding the role of dermatology at the World Health Organization and beyond.  J Invest Dermatol. 2014;134(11):2663-2665.PubMedGoogle ScholarCrossref
21.
The International Foundation for Dermatology. Our aim. http://www.ifd.org. Accessed August 31, 2016.
23.
Lekalakala  PT, Khammissa  RA, Kramer  B, Ayo-Yusuf  OA, Lemmer  J, Feller  L.  Oculocutaneous albinism and squamous cell carcinoma of the skin of the head and neck in sub-Saharan Africa.  J Skin Cancer. 2015;2015:167847.Google ScholarCrossref
24.
International Foundation for Dermatology. Progress report 2015-16. http://www.ifd.org/IFD/media/IFD/Misc/IFD-Progress-Report-2015-2016.pdf. Accessed September 2, 2016.
25.
The Cochrane Collaboration. About us. http://www.cochrane.org/about-us. Accessed August 30, 2016.
26.
Cochrane Skin. Prioritisation of dermatological research. http://skin.cochrane.org/prioritisation-dermatological-research. Accessed August 30, 2016.
27.
Karimkhani  C, Boyers  LN, Prescott  L,  et al.  Global burden of skin disease as reflected in Cochrane Database of Systematic Reviews.  JAMA Dermatol. 2014;150(9):945-951.PubMedGoogle ScholarCrossref
28.
Shiffman  J.  Knowledge, moral claims and the exercise of power in global health.  Int J Health Policy Manag. 2014;3(6):297-299.PubMedGoogle ScholarCrossref
29.
Rudan  I, Chan  KY.  Global health metrics needs collaboration and competition.  Lancet. 2015;385(9963):92-94.PubMedGoogle ScholarCrossref
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