Burden of skin disease and associated socioeconomic status in Asia: A cross-sectional analysis from the Global Burden of Disease Study 1990-2017

Abstract

Introduction: Skin diseases have a significant global impact on quality of life, mental health, and loss of income. The burden of dermatologic conditions and its relationship with socioeconomic status in Asia is currently not well understood.

Methods: We selected Global Burden of Disease Study datasets to analyze disability-adjusted life years (DALYs) in 50 Asian countries, including Central Asia, northern Asia, eastern Asia, western Asia, southeastern Asia, and southern Asia, between 1990 and 2017. We compared DALYs to the socioeconomic status using the sociodemographic index and gross domestic product per capita of a country. Statistical analysis was performed using Pearson's correlation.

Results: Some countries had higher or lower than expected age-standardized DALY rates of skin diseases. Asian countries, especially high-income countries, had a high burden of inflammatory dermatoses, including acne, alopecia areata, atopic dermatitis, contact dermatitis, decubitus ulcers, psoriasis, pruritus, and seborrheic dermatitis. The burden of infectious dermatoses was greater in low-income Asian countries. The burden of skin cancer in Asia was relatively low.

Conclusion: There is a high burden of skin disease, especially inflammatory conditions, in Asian countries, but the burden of individual dermatoses in Asia varies by country and socioeconomic status. DALYs can potentially serve as a purposeful measure for directing resources to improve the burden of skin disease in Asia.

Keywords: AA, Alopecia areata; DALYs, disability-adjusted life years; GBD, Global Burden of Disease; GDP, gross domestic product; Global Burden of Disease Study (GBD) database; NMSC, nonmelanoma skin cancer; SDI, sociodemographic index; acne; age-standardized prevalence rates; alopecia; atopic dermatitis; basal cell carcinoma; disability-adjusted life years (DALYs); global medicine; gross domestic product (GDP) per capita; infectious disease; itch; leishmaniasis; melanoma; nonmelanoma skin cancer (NMSC); pruritus; psoriasis; scabies; skin cancer; socioeconomic status; squamous cell carcinoma; syphilis; tuberculosis; urticaria; viral skin diseases.

Fig 1

Age-standardized DALY rates caused by skin and subcutaneous diseases by SDI for Asian countries in 2017. DALY, Disability-adjusted life years; SDI, sociodemographic index.

Fig 2

Age-standardized DALY rates caused by melanoma (blue) and nonmelanoma skin cancer (orange) by SDI for Asian countries in 2017. DALY, Disability-adjusted life years; SDI, sociodemographic index.

Fig 3

Heat table with Asian countries placed in ordered in a heat table with in rows from the highest (most wealthy) to the lowest (least wealthy), and); each country was numerically ranked in the world from 1 (red, highest DALYs) to 195 (blue, lowest DALYs) for each disease in 2017. AA, Alopecia areata; ACN, acne; AST, asthma; ATO, atopic dermatitis; BCC, basal cell carcinoma; CEL, cellulitis; CON, contact dermatitis; DALY, disability-adjusted life year; DEC, decubitus ulcer; FUN, fungal skin disease; MEL, melanoma; NMS, nonmelanoma skin cancer; ORA, oral/lip cancer; PRU, pruritus; PSO, psoriasis; PYO, pyoderma; SCA, scabies; SCC, squamous cell carcinoma; SEB, seborrheic dermatitis; SYP, syphilis; TUB, tuberculosis.; URT, urticaria; VIR, viral skin disease.

Fig 3

Heat table with Asian countries placed in ordered in a heat table with in rows from the highest (most wealthy) to the lowest (least wealthy), and); each country was numerically ranked in the world from 1 (red, highest DALYs) to 195 (blue, lowest DALYs) for each disease in 2017. AA, Alopecia areata; ACN, acne; AST, asthma; ATO, atopic dermatitis; BCC, basal cell carcinoma; CEL, cellulitis; CON, contact dermatitis; DALY, disability-adjusted life year; DEC, decubitus ulcer; FUN, fungal skin disease; MEL, melanoma; NMS, nonmelanoma skin cancer; ORA, oral/lip cancer; PRU, pruritus; PSO, psoriasis; PYO, pyoderma; SCA, scabies; SCC, squamous cell carcinoma; SEB, seborrheic dermatitis; SYP, syphilis; TUB, tuberculosis.; URT, urticaria; VIR, viral skin disease.