� 

PLIBLICAT’KINSDRANC 

o 

FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

U.S. DEPARTMENT OF HEALTH, � public Health Serwce


EDUCATION, AND WELFARE Office of Health Research, Statistics, and Technology Number47 � April 3,1979


Prevalence, Disability, and Health Care for Psoriasis 

Among Persons 1-74 Years: United Statese 

a


This report presents national estimates for 

the prevalence of psoriasis and related pathology, the resultant concern and handicap, 

and the need for heaIth care for these conditions 

among the civilian noninstitutionalized popuIation 1-74 years of age in the United States. 

The data are based on direct examination 

findings from the Health and Nutrition Examination Survey (HANES) of 1971-1974. 

The first HANES program, in which these 

data were obtained, was desicgnedto measure the 

nutritional status as well as certain aspects of 

generaI health status and health care needs in 

the U.S. population. These programs secure 

information on the prevalence of medicalIy defined illnesses, including previously unrecognized and undiagnosed conditions, as well as 

on a variety of physical, physiological, and 

psychological measures within the population 

through direct examinations, tests, and measurements, as described in previous publications.1 ‘A 

The dermatology component of the first 

HANES was planned at the request of and in cooperation with the Committee on Planning for 

the National Program for Dermatology of the 

National Academy of Dermatology. Dr. MarieLouise T. Johnson, Chairman of the Data Collection Unit for the National Program, was 

primarily responsible for planning the content 

of the examination, recruiting the dermatologists, and training them in the examination 

methodology to minimize variation ~ong 

examiners. 

aprepared by Marie-Louise T. Johnson, M.D., Ph.D., 

New York University School of Medicine, and Jean 

Roberts, M.S., Division of Health Examination Statistics. 

This second Advance Data from the dermatology examination findings is limited to statistics on persons identified by the examiner as 

having psoriasis as classified under code 7060 

in the Code of Skin Diseases. 5 Further information on the demographic and socioeconomic 

distribution of all types of skin pathology, 

the extent of disability or handicap caused by 

skin conditions, and the extent to which medicaI 

care for such conditions has been sought or 

needed among the U.S. population is summarized in an earlier Advance Data6 and further 

described and analyzed in a Vital and Health 

Statists-cs series report.7 These data augment 

those included for psoriasis in the previously 

published report. 

TRENDS 

An estimated 5.8 per 1,000 persons 1-74 

years of age in the U.S. civiIian noninstitutionalized population have psoriasis as determined in the dermatology component of the 

Health and Nutrition Examination Survey of . 

1971-1974. An additional 0.4 per 1,000 were 

shown in the detailed examination to have active 

psoriasis. Nearly 70 percent of those afflicted 

were concerned enough to complain about their 

condition, a rate of 4.0 per 1,000 population 

(table 1). 

Psoriasis is a chronic condition of the skin 

that usually appears first in the third decade of 

Iife but may appear at any time and can be seen 

in children. Classicality, there are red plaques 

with silvery scales over the elbows and knees, 

and occasionally the scalp, but psoriasis may become evident sudderdy over the entire body as 
2 ID 

Table 1. Prevalence and prevalence rates among persons 1.7’4 years of age for all psoriasis diagnosed and such conditions evoking 

complaints, by type of condition and sex, with standard errors for total rates: United States, 1971-1974 

Significant pathology Complaints 

Type of psoriatic pathology and 

New York University code Both Both , Male Female Male Female sexes sexes 

Number of persons in thousands 

Psoriasis,all types ....... .......................................7O6O 1,117 594 803 401 402 

Rupial ........................................................7O6O5O 7 7 \ 

Guttate . .................................................... 706060 3’ 3 

With atihritis ............................................. 706070 50 39 11 

Types N.O.S.l ...........................................7O6O9O 1,065 556 

523‘151 

- 363 

13 

508 745 1’38 382 

Rate per 1,000 population 

Psoriasis......... ....... .............................................. 7060 5.8 6.3 5.3 4.0 4.1 4.0 

Rupial ........................................................7O6O5O *0.04 *0.07 

Gutiate ............... .......................................7O6O6O *0.01 *0.02 

With amhritis ................................... ..........7O6O7O *0.25 *0.41 *0. I 1 “0.26 *0.41 *0. I 3 

Types N.O.S.l ...........................................7 O6O9O 5.49 5.90 5.09 3.84 3.85 3.82 

Standard error of rate 

Psoriasis..... ................. ........................................7O6O 1.08 0.93 0“76 II1“10

I ~.o.s._not Othewisespecified. 

small, scattered, drop-like lesions of redness and 

scale, so-called .guttate psoriasis. Pitting of the 

nails can be seen with lifting and fl-aring, a 

form of psoriasis that may be associated with 

arthritis.8‘g 

Although found in families, psoriasis is inherited in a pattern still unclear. Through 

genetic markers a group of psoriatic patients can 

be identified who have a high rate of affected 

relatives, a younger onset of disease, and a more 

severe forrn. 

The HANES dermatologists recorded the 

presence of psoriasis, its extent and severity, the 

presence or absence of scalp involvement, and 

arthritis. The most frequently diagnosed type of 

the disease was psoriasis vulgaris, otherwise unspecified (afflicting 95 percent of those with 

psoriasis diagnosed in the survey). Individuals 

who had an associated arthritiswere 4.0 percent 

of the total; the remaining 1.0 percent had 

guttate psoriasis, the explosive form sometimes 

associated with physiological stress such as fever, 

or specific therapy such as antibiotics. 

Psoriasis was found slightly more frequently 

among males (6.3 per 1,000) than females (5.3 

per 1jOOO),although the difference in rates was 

small enough to be due to sampling variability 

alone. The complaint rate was similar for both 

sexes (4.1 and 4:0 per 1,000). 

As would be expected with a problem beginning in most people after age 20, the prevalence 

rates for psoriasis were lowest among children 

6-11 years and adults 1844 years of age (less 

than 2 per 1,000), and highest among adults 45-

74 years (1 1-12 per 1,000 population). 

Complaints concerning their skin pathology 

were correspondingly lower among children and 

younger adults (through age 44), with rates of 

1-3 per 1,000 population (table 2). For persons 

age 45 years or older rates decreased slightly 

with age from 10 per 1,000 population at 45-54 

years to 7 per 1,000 at 65-74 years (figures 1-3). 

Race made a difference in the prevalence of 

psoriasis. White persons were affected more than 

black persons (6.5 per 1,000 against 0.6 per 

1,000). Correspondingly more white persons 

(4.5 per 1,000) than black persons (0.4 per 

1,000) registered concern about their condition, 
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Table 2. Prevalence rates for all psoriasis diagnosed and such conditions evoking complaints, proportion considering psoriasis a handicap 

by severity, age, sax, and race among parsons 1-74 years of age, with standard errors for totals: United States, 1971-1974 

Both sexes All races, Both sexes, All races, 

Condition or I 1-74 years I 1-74 years 1-74 years 

handicap 1-74 1-17 18-44 45-74 Male 

years years years years ==t=T= 

Rate per 1,000 population Standard error 

All psoriasis 

diagnosed.................. 5.8 2.4 4.3 11.6 I 6.3 ‘15.3 6.5 0.6 0.76 1.10 1.09 

Psoriasisevoking 

complaints ................. 4.0 1.2 2.8 8.9 4.1 4.0 4.5 0.4 0.58 0.86 I 0.93 

Percent 

Some employment or 

housework handicaps 

among persons wit h: 

Psoriasisdiagnosed., 7.5 9.3 6.9 7.3 7.0 8.1 7.2 2B.2 3.42 3.78 5.24 

Psoriasis evoking 

complaints .......... .. 11.2 19.0 10.7 10.2 10.8 11.6 10.8 42.7 4.62 5.71 7.68 

Preferred employment 

precluded among 

persons with: 

� 

Psoriasisdiagnosed. 0.8 1.4 1.5 0.8 0.78 1.47 

Psoriasisevoking 

complaints ............ 1.3 1.8 2.3 1.4 1.62 2.21 

.%ma social handicap 

among persons with: 

Psoriasis diagnosed. 23.3 14.8 25.8 24.0 24.5 21.9 23.2 28.2 5.38 7.47 7.20 

Psoriasisevoking 

complaints .... ..... ... 38.5 30.4 35.6 41.0 36.4 40.5 38.4 42.7 7.23 11.33 11.13 

Percent distribution of persons with psoriasis evoking complaints 

By severity of employment or housework 

handicap: 100.0 100.0 100.0 100.0 100.0 100.0 

Totally 

handicapped ......... 0.3 0.2 0.1 

Partial-severe........... 2.5 9.6 4.9 0.2 .-. 

Partial-mini real ...... 8.6 19.0 1.0 10.1 5.7 11.1 

Essentially none..... 88.8 81.0 8B.2 88.9 89.4 88.6 -.. 

By severity of social 

handicap: 

severe .................... 0.3 0.5 0.3 ..- -.. 

Minimal................. 93.0 30.4 35.1 37.0 35.6 35.2 ..- ..- -.. 

Essentially none .... 6.7 69.6 64.4 63.0 64.4 64.5 . . . -.. . . . 

differences too large to be attributable to sam- WMe complicating life and compromising 

pling variability alone (table 2). Among both employment and housework for some persons, 

raci~ groups, concern was expressed for_about psoriasis was more likely to be considered a 

two-thirds of the diagnosed psoriasis conditions. soczid handicap. It was considered such by 23.3 

Of all psonatics with complaints about percent of those with significant disease and 

their skin condition, nearly three-fourths (71.9 38.5 percent of those who were concerned 

percent) had the problem for more than 5 about their condition. Only 7.5 percent of all 

years; only 6.3 percent had been aware of it for persons with psoriasis and 11.2 percent of those 

less than 2 years. The psoriasis had been active concerned about their psoriasis complained 

@ in the preceding year in all but 25 percent. about interference with employment or house-
.

4 achancedata 

*


Figure 1. PREVALENCE RATES FOR ALL PSORIASIS DIAGNOSED’ 

AND PSORIASIS EVOKING COMPLAINTS, BY AGE UNITED 

STATES, 1971-74 

20 

g 15 

5 [ Diagnosed 

/. ....... o I 1 1 1 1 I 

o 10 20 30 40 w 60 70 

AGE IN YEARS 

I NewYork Universitycode7060.5 

Figure 2. PREVALENCE RATES FOR ALL PSORIASIS DIAGNOSED) 

BY AGE AND SEX UNITED STATES, 1971-1974 

20F Males 

AGE IN YEARS 

1NewYork UniverW code7060.5 

work. The proportion of those affected with 

either a social or work handicap increased 

consistently with age (table 2). Males were 

somewhat less likely than females to consider 

their psoriasis a handicap to work, but if they 

were concerned, they were more apt than 

females to consider it a social handicap. Of 

interest despite their fewer numbers, black 

persons were substantially more likely than 

white persons to consider their psoriatic condition a handicap to employment or housework 

and somewhat more likely to complain of a social handicap. 

Fi9ure 3. PREVALENCE RATES FOR PSORIASIS EVOKING COM. 

PIAINTS: BY AGE AND SEX UNITED STATES, 1971-1974 

20 

[ 

.-. 

~. .... Males 

~ 10 - ;“ ., 

~. .. 

K ;. u. 

. ;. 

: ;. 

CJ 

5 — 

.:” 

0 ,. I 

10 20 30 40 50 60 70 

AGE IN YEARS 

1NewYork Unlveraltycode7060.5 

The majority of individuals with psoriatic 

skin problems considered themselves without a 

handicap to work (89 percent) or social functioning (61 percent). Among those who did feel 

a handicap to employment or housework, the 

handicap was more likeIy to be thought of as e 

minimal (8.6 percent) than severe (2.5 percent), 

and the social handicap was almost always considered minimal (93 percent). 

Among those examined, psoriasis was more 

apt to be active rather than inactive (6.2 per 

1,000 population against 1.3 per 1,000 for those 

with inactive disease). For those under 45 years 

of age, the ratio was 3 to 1, and it increased to 7 

active to 1 inactive in individuals over the age of 

45 afflicted with psoriasis (table 3). 

Psoriasis was found more frequently on both 

scalp and extremities (2.9 per 1,000 population) 

than on just the extremities (2.3 per 1,000) or 

only the scalp (O.5 per 1,000). When psoriasis 

occurred elsewhere on the body, the trunk alone 

was more likely to be affected (1.9 per 1,000) 

than the trunk and seborrheic areas other than 

the scalp (0.8 per 1,000) or these latter areas 

alone (0.3 per 1,000). 

More than half of those with psoriasis knew 

of no family history of this problem (5.2 per 

1,000 population). Of those reporting a family 

history, the parents were more likely to have 

had the condition (2.0 per 1,000 population) 

than 

parents 

sibIings 

and siblings 

alone 

(0.5 

(1.1 

per 

per 

1,000). 

1,000) or both o
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dEmdata5 

Table 3. Prevalence rates among persons 1-74 years of age for psoriasis by severity, anatomical locations, family history, adequacy of 

medical care, obstacles to improvement, age and sex, with standard errors for totals: United States, 1971-1974 

Selected characteristics related Both S12XeS I 1-74 years 1-74 years 

to psoriasis condition 1-74 I 1-17 I 1B-44 45-74 

years years years I years I 

Male I Female 

Activity of rendition Rate per 1,000 population ‘ Standard error of rate 

Active . .. .. .. . ... .. .. ... .. .. .... ... . . ... . ... .. . ..... . ... ... .. .. . 6.2 1.9 4.2 14.1 7.2 5.3 0.76 1.16 1.05 

Inactive . .. .. .. .. ... . .. .. .. ...... .. .. .. . .... . ... .... .. .. .. ... ... 1.3 0.7 1.3 1.8 0.4 2.1 0.45 0.23 0.74 

Severity of condition 

%wre .. ... . .... .. ...... . .. ... .. ... . .. .. .... .. . ... .. . .. .. .. . .... �ool 0.1 0.0 �0.O �0.1 0.04 0.01 0.08 

Wderate . .. ... . .. .. .. .. .... .. .. .. .. . . ... . .. ... ... ... .. .. .. ... 2.1 1.6 5.2 2.3 1.9 0.39 0.52 0.59 

Minimal . .. ... ... . ... .... .... .. .. .. .. .. .. .. ... ... .. . ... .. . .. ... 4.9 3.5 3.4 10.2 5.2 4.6 0.63 1.06 1.03 

Location of condition 

Scalp only .. ... .... ... .... .. .. ... . .... . .. . .... .. .. .... . .. .... 0.5 0.1 0.1 1.3 0.2 0.7 0.17 0.22 0.28 

Extremities only . . ..... . .. ... ... . .. .. . ..... .. . .... .. . .. .. 2.3 0.7 2.1 4.2 2.3 2.2 0.48 0.66 0.67 

Both scalp and extremities . ... . .. ... .. .. .. ... . . ... .. 2.9 1.1 2.3 6.0 3.0 2.8 0.51 0.59 0.72 

Trunk only . ... ... .. .. .. ... ... .. .. .. .. . . ..... . .. . ... .. .. ... . . 1.9 1.1 0.7 4.6 2.0 1.5 0.51 0.88 0.57 

Seborrheic areas only .. ... .. .. .. .. .. ... .. .. .... . .. ... . . 0.3 0.2 0.1 0.9 0.7 0.19 0.02 0.38 

Both trunk and seborrheic areas . ... .. ... . .. ... . .. 0.8 0.6 2.0 0.9 0.8 0.25 0.36 0.38 

n Family history of psoriasis 

Parent only . ..... . . .... . .. .... .. . ... .. .. .. .. ... .. ... . .... .. . . 2.0 1.1 2.7 2.2 2.1 1.9 0.49 0.56 0.62 

Sibling only ... .. .. ..... .. .. .. .. . ... .. . ... .. .. ... ... .. . ..... . 1.1 0.4 1.1 1.8 �1.4 0.9 0.46 0.87 0.30. 

Both parent and sibling . . .. ... . .. ... . .. .... ... . . ... .. . �0.5 “0.3 *0.5 “0.9 “0.4 ‘0.7 0.27 0.22 0.49 

None . .. ... .. .. ... ... . .... .... ... . .. .... . .. ... ... .... . .. .... .. . .. 5.2 . . . . . . 6.2 4.0 0.66 1.26 0.90 

Adequacy of medical care for psoriasis 

Ad~uate . .. .. .. .. .. .. .. .... ... .. ... .. . ... . .. ..... .. ... .. .. ... 2.4 0.9 2.0 4.6 2.0 ; 2.7 0.38 0.65 0.66 

inadequate . . .... .. . ...... .... . .. ... . .. ... . .. .... .. ..... . ... .. 1.0 0.1 0.2 3.0 1.0 0.9 0.32 0.51 0.40 

Wne .. ... .. . .... ... . ... .. .. .... .. .. .. .. .. .. .. . ..... .. ....<...... 0.7 0.2 0.5 1.4 1.1 0.3 0.22 0.42 0.22 

Obstacles to improvement 

for psoriasis comcdaint 

Did not Cooperate with doctor .................... *0.E �0.1 ‘0.4 1.5 *1.O �0.3 0.03 0.06 0.02 ‘ 

Financial ............................................... ...... �0.i �. +0.1 “0.6 ‘0.3 �0.3 0.13 0.09 0.24 

Other (too far, no transportation 

available, etc.) ..... ........................ .............. 

The medical care received bv those with 

psoriasis was judged by the ex&iner as adequate or inadequate according to common 

norms for therapy provided by dermatologists in 

outpatient settings. The assessment was more 

oft;n of adequ;te treatment (2.4 per 1,000 

population) than inadequate or nonexistent 

treatment (1.7 per 1,000) for all ages combined 

0.4 1.2 0.31 0.03 

and for persons under 45 years of age. For those 

age 45-74 years, however, the care was just as 

likely to be inadequate or nonexistent as it was 

to be adequate. Obstacles to improvement were, 

in most instances, due to lack of time or concern 

rather than because of financial constraints or 

inadequate professional advice. 

0.61 
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6


‘T


REFERENCES 

lNational Center for Health Statistics: Plan and 

initial program of the Health Examination Survey. 

Vital and Health Statistz”cs. PHS Pub. No. 1000-Series 

l-No. 4. Public Health Service. Washington. U.S. GovernmentPrinting Office, July 1965. 

2National Center for Health Statistics: Plan, operation, and response results of a program of children’s 

examinations. Vital and HeaM Statistics. PHS Pub. No. 

1000-Series l-No. 5. Public Health Service. Washington. 

U.S. Government Printing Office, Oct. 1967. 

3National Center for Health Statistics: Plan and 

operation of a Health Examination Survey of U.S. 

youths 12-17 years of age. Vital and Health Statistics. 

PHS Pub. No. 1000-Series l-No. 8. Public Health Service. Washington. U.S. Government Printing Office, 

Sept. 1969. 

4Nationd Center for Health Statistics: Plan and 

operation of the Health and Nutrition Examination 

Survey, United States, 1971-1 97!3, by H. W. Miller. Vital 

and Health Statistics. Series I-Nos. 10a and 10b. DHEW 

Pub. Nos. (HRA) 76-1.310 (lOa) and (HSM) 73-1310 

( 10b). Health Resources Administration. Washington. 

U.S. Government Printing Office, Feb. 1973. 

t 

5The Department of Dermatology, New York University School of Medicine: Code of Skin Diseases, 1st 

rev. New York. New York University, Feb. 1968. 

6National Center for Health Statistics: Prevalence 

of dermatologica.1 disease among persons 1-74 years of 

age, United States, by M.-L. T. Johnson and J. Roberts. 

Advance Data From Vital and Health Statistics, No. 4. 

DHEW Pub. No. (HRA) 77-1250. Health Resources 

Administration. Rockville, Md. Jan. 26, 1977. 

‘National Center for Health Statistics: Skin conditions and related need for medical care among persons 

I-74 years, United States, 1971-1974, by M.-L. T. 

Johnson and J. Roberts. Vital and Health Statistics. 

Series 1 l-No. 212. DHEW Pub. No. (PHS) 79-1660. 

Public Health Service. Washington. U.S. Government 

Printing Office. Nov. 1978. 

8 Fitzpatrick, T. B., Eisen, A. Z., Wolff, K., Freedberg, I. M., and Austen, K. F., eds.: Dermatology in 

General Medicine. New York. McGraw-Hill Book Co., 

1979. 

9Moschella, S. L., Pillsbury, D. M., and Hurley, J. J., 

Jr.: Dermatology, 2d ed. Phila., Pa. W. B. Saunders Co., 

1975. 

-

SYMBOLS 

Data not available----------------------------------—-

Category not applicable . . . 

Quantity zero ---------------------------------------- -

Quantity more than O but less than 0.05---- 0.0 

Figure does not meet standards of 

reliability or precision--— * 
dmcdata7 

TECHNICAL NOTES 

The sampling plan for the 65 preselected 

examination locations throughout the country 

that were used consecutively in the Health and 

Nutrition Examination Survey from April 1971 

through June 1974 followed a stratified multistage probability design in which a sample of the 

civilian noninstitutionalized population of the 

coterminous United States 1-74 years of age was 

selected. The sample was stratified by geographic region, population density, and rate of 

population change between 1960 and 1970. 

Within each stratum, cluster-type sampling was 

used for selecting households and sample persons to be included in each examination location. The sample design provided for oversampling among persons living in poverty areas, 

preschool-age children, and women 20-44 years 

of age. 

Of the 28,043 sample persons selected to 

represent the 194 million persons 1-74 years of - age in the U.S. population, 20,749, or 74.0 percent, were examined. This corresponds to an 

effective response rate of 75.2 percent after adjustment is made for the effect of oversampling 

among the poor, preschool-age children, and 

women 20-44 years of age. 

This dermatology part of the HANES examination included a complete clinical examination of the skin and surrounding tissue that 

considered normal variations in texture and 

-

color, certain manifestations of aging, and all 

pathological changes. Significant diagnoses were 

documented by tissue biopsy to determine 

malignancy or culture to identify fungi whenever possible. Estimates were made of actinic 

exposure experienced as well as actinic damage 

sustained and of occupational risk from irritant 

and allergic contactants. For an examinee with 

a significant hand, foot, or generalized problem, 

the dermatologist made a judgment about the 

burden to the examinee in terms of discomfort 

or disability, about care sought, and about the 

effect expected from current best care possible. 

The “significant” skin conditions or pathologies 

recorded are those the examining dermatologist 

thought should be evaluated by a physician at 

least once. 

Prevalence rates of skin conditions are 

shown as population estimates; that is, the examination findings for each individual have been 

“weighted” by the reciprocal of the probability 

of selecting the person. An adjustment for persons in the sample who were not examined and 

a poststratified ratio adjustment were also made 

so that the final sample estimates of population 

size agree exactly with independent U.S. Bureau 

of the Census estimates for the civilian noninstitutionalized population of the United States 

as of November 1, 1972, by color, sex, and age. 

—-
Recent Issues of Advance Data From Vital and Health Statistics 

No. 46.	 Hemoglobin and Selected Iron-Related I%dings of Persons 1-74 Years of Age: United 

States, 1971-74 (Issued: Januery 26, 1979) 

No. 45.	 Use of Family Planning Services by Currently 

Married Women 15-44 Years of Age: United 

States, 1973 and 1976 (Issued: 

No. 44.	 Health Care Coverage: United States, 1976 (In 

prepsration) 

No. 43.	 Use of Intrautesiue Contraceptive Devices in 

the United States (Issued: December 12, 

1978) 

No. 42.	 Office Wsits to cardiovascular Specialists, 

National Ambulatory Medical Care Survey: 

United States, 1975-76 (Issued: October 31, 

1978) 

A complete list of Advance Data From Vital and Health Statistics is available from the Scientific and Technical 

Information Brarrch. 

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