Global Skin Disease Morbidity and Mortality: An Update From the Global Burden of Disease Study 2013

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.

Conflict of interest statement

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.

Figures

Figure 1.. Age Distribution of Skin and Subcutaneous Disease Burden

This figure shows disability-adjusted life year (DALY) rate per 100 000 persons from 15 skin disease categories throughout the human life span.

Figure 2.. Regional Distribution of Skin and Subcutaneous Disease Burden

This figure shows disability-adjusted life year (DALY) rate per 100 000 persons from 15 skin disease categories throughout 21 world regions.