National, regional, and worldwide epidemiology of psoriasis: systematic analysis and modelling study

Abstract

Objective: To systematically review and provide information on the incidence of psoriasis and quantify global, regional, and country specific estimates of its prevalence.

Design: Systematic review and meta-analysis.

Data sources: Medline, Embase, Web of Science, SciELO, Korean Journal Databases, Russian Science Citation Index, WPRIM, SaudiMedLit, Informit, IndMed, and HERDIN were searched systematically from their inception dates to October 2019.

Methods: Studies were included if they reported on the incidence or prevalence of psoriasis in the general population. Incidence data were summarised descriptively, whereas bayesian hierarchical models were fitted to estimate the global, regional, and country specific prevalence of psoriasis.

Results: 41 164 records were identified and 168 studies met the inclusion criteria. In adults, the incidence of psoriasis varied from 30.3 per 100 000 person years (95% confidence interval 26.6 to 34.1) in Taiwan to 321.0 per 100 000 person years in Italy. The prevalence of psoriasis varied from 0.14% (95% uncertainty interval 0.05% to 0.40%) in east Asia to 1.99% (0.64% to 6.60%) in Australasia. The prevalence of psoriasis was also high in western Europe (1.92%, 1.07% to 3.46%), central Europe (1.83%, 0.62% to 5.32%), North America (1.50%, 0.63% to 3.60%), and high income southern Latin America (1.10%, 0.36% to 2.96%).

Conclusions: Eighty one per cent of the countries of the world lack information on the epidemiology of psoriasis. The disease occurs more frequently in adults than in children. Psoriasis is unequally distributed across geographical regions; it is more frequent in high income countries and in regions with older populations. The estimates provided can help guide countries and the international community when making public health decisions on the appropriate management of psoriasis and assessing its natural history over time.

Systematic review registration: PROSPERO CRD42019160817.

Fig 1

Distribution of number of studies included in statistical analysis by country. Countries with no observed data are white

Fig 2

Crude lifetime (physician or dermatologist diagnosed) prevalence of psoriasis for overall population according to world regions. Regions with observed data: Australasia, central Europe, east Asia, eastern Europe, eastern sub-Saharan Africa, high income Asia Pacific, high income North America, North Africa and the Middle East, south Asia, South East Asia, tropical Latin America, western Europe. Regions with extrapolated data: central Asia, high income southern Latin America, Caribbean, Andean Latin America, central Latin America, Oceania, central sub-Saharan Africa, southern sub-Saharan Africa, western sub-Saharan Africa

Fig 3

Crude lifetime (physician or dermatologist diagnosed) prevalence of psoriasis in children according to world regions. Regions with observed data: Australasia, central Europe, east Asia, eastern Europe, eastern sub-Saharan Africa, high income Asia Pacific, high income North America, North Africa and the Middle East, south Asia, South East Asia, tropical Latin America, western Europe. Regions with extrapolated data: central Asia, high income southern Latin America, Caribbean, Andean Latin America, central Latin America, Oceania, central sub-Saharan Africa, southern sub-Saharan Africa, western sub-Saharan Africa

Fig 4

Crude lifetime (physician or dermatologist diagnosed) prevalence of psoriasis in adults according to world regions. Regions with observed data: Australasia, central Europe, east Asia, eastern Europe, eastern sub-Saharan Africa, high income Asia Pacific, high income North America, North Africa and the Middle East, south Asia, South East Asia, tropical Latin America, western Europe. Regions with extrapolated data: central Asia, high income southern Latin America, Caribbean, Andean Latin America, central Latin America, Oceania, central sub-Saharan Africa, southern sub-Saharan Africa, western sub-Saharan Africa

Fig 5

Lifetime (physician or dermatologist diagnosed) prevalence of psoriasis in adults by country. Details about countries with observed or extrapolated data are given in fig 1 and supplementary material 2 (eTables 6-11)