Minimal improvements in the global burden of skin disease from 1990 to 2013
Authors: Jessica Mounessa, Taylor Braunberger, Cory A. Dunnick, Robert P. Dellavalle
Journal: Journal of the American Academy of Dermatology (2016)

To the Editor: Skin disease often impairs quality of life and results in an increase in years lived with disability (YLDs). In 2010, skin disease was the fourth cause of nonfatal disease burden worldwide.1Hay R.J. Johns N.E. Williams H.C. 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: 1527-1534Abstract Full Text Full Text PDF PubMed Scopus (794) Google Scholar Skin conditions ranked between the second and eleventh leading causes of YLDs globally.1Hay R.J. Johns N.E. Williams H.C. 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: 1527-1534Abstract Full Text Full Text PDF PubMed Scopus (794) Google Scholar We investigated changes in the global burden of skin disease experienced in developed and developing countries between 1990 and 2013. We used the Institute for Health Metrics and Evaluation (IHME) reports of Leading Causes of YLDs, 1990 and 2013.2Institute for Health Metrics and Evaluation website. Country profiles. Available at: http://www.healthdata.org/results/country-profiles. Accessed May 24, 2016.Google Scholar The percent change in skin diseases between 1990 and 2013 was collected for each country listed. Of the 187 reported countries, we identified 47 developed countries according to the 2015 Human Development Index.3United Nations Development Programme website. Human development eports. Available at: http://hdr.undp.org/en/2015-report. Accessed May 24, 2016.Google Scholar The greatest improvements were seen in Portugal, with a 9% decrease in disability between 1990 and 2013. Israel, Spain, the Czech Republic, and Hungary followed the lead with a 7% decrease in YLDs. In addition, 6 of the 47 developed countries did not see any changes in YLDs from skin conditions, and 11 experienced an increase in their YLDs (Fig 1). The mean percent change seen in developed countries was a 1.85% improvement in disability (standard deviation [SD] = 3.73 [95% confidence interval {CI}, −2.92 to −0.78]). Of the 140 developing countries, 26 reported improvements in YLDs from skin diseases, as indicated by a negative percent change from 1990 to 2013 (Fig 2). The average percent change in developing countries was a 2.6% decrease in disability (SD = 3.75 [95% CI, 2.04-3.29]). Ten countries saw no change, and the majority of developing countries (n = 104) experienced an increase in disability. Nicaragua, Oman, and Palestine saw the greatest increase in percent change of disability (11%, 11%, and 15%, respectively). Skin diseases continue to affect not only those living in developing countries, but also those living in developed countries. The decrease experienced in the United States was low (1%), especially when compared to other developed countries. In other words, the percentage of Americans living in less than ideal health because of skin diseases has not changed substantially in the past 23 years, even though the United States has been spending far more on health care than any other developed country.4Squires D. Anderson C. U.S. health care from a global perspective: spending, use of services, prices, and health in 13 countries.Issue Brief (Commonw Fund). 2015; 15: 1-15PubMed Google Scholar An increase in life expectancy of Americans may partially account for a larger number of people living in the United States with skin diseases. Yet most of the developed countries have also experienced an increase in life expectancy. This therefore does not fully explain why the United States lags behind the majority of developed countries in terms of improvements in disability from skin disease. In addition, Americans may have higher expectations regarding treatment of skin diseases as a result of direct-to-consumer pharmaceutical advertising, which may overemphasize potential benefits of medications.5Ventola C.L. Direct-to-consumer pharmaceutical advertising: therapeutic or toxic?.P T. 2011; 36: 669-684PubMed Google Scholar Patient expectations are unaccounted for in the IHME data. Over the past 2 decades, the majority of both developed and developing countries have experienced little or no improvement in disability caused by skin diseases. Health care providers around the world must shift their focus to improving the quality of lives in their patients with skin diseases. Poland – POL Taiwan – TWN Korea – KOR Denmark – DNK Finland – FIN Greece – GRC Italy – ITA Luxembourg – LUX Montenegro – MNE The Netherlands – NLD Slovakia – SVK Australia – AUS Cyprus – CYP Japan – JPN Latvia – LVA Malta – MLT Singapore – SGP India – IND Iran – IRN Pakistan – PAK Rwanda – RWA Vietnam – VNM Angola – AGO Dominican Republic – DOM Haiti – HTI Malaysia – MYS Maldives – MDV Sao Tome and Principe – STP Swaziland – SWZ Thailand – THA Uzbekistan – UZB Zimbabwe – ZWB Botswana – BWA Costa Rica – CRI Democratic Republic of the Congo – RCB El Salvador – SLV Gabon – GAB Laos – LAO Lesotho – LSO South Sudan – SSD Tanzania – TZA Central African Republic – CAF Guinea – GIN Indonesia – IDN Lebanon – LBN Mongolia – MNG Mozambique – MOZ Myanmar – MMR South Africa – ZAF Afghanistan – AFG Albania – ALB Azerbaijan – AZE Congo – COG Dominica – DMA Equatorial Guinea – GNQ Federated States of Micronesia – FSM Honduras – HND Jamaica – JAM Kiribati – KIR Liberia – LBR Mauritius – MUS Nigeria – NGA Suriname – SUR Togo – TGO Trinidad and Tobago – TTO Tunisia – TUN Turkey – TUR Uganda – UGA Algeria – DZA Barbados – BRB Belize – BLZ Bolivia – BOL Burundi – BDI China – CHN Cote d'Ivoire – CIV Eritrea – ERI Malawi – MWI Mexico – MEX Morocco – MAR Namibia – NAM Philippines – PHL Saint Vincent and the Grenadines – VCT Senegal – SEN Seychelles – SYC Sri Lanka – LKA Syria – SYR Tajikistan – TJK The Bahamas – BHS Turkmenistan – TKM Uruguay – URY Armenia – ARM Brazil – BRA Chad – TCD Colombia – COL Cuba – CUB Ethiopia – ETH Guatemala – GTM Moldova – MDA Panama – PA Papua New Guinea – PNG Sierra Leone – SLE Somalia – SOM Timor-Leste – TLS Antigua and Barbuda – ATG Ecuador – ECU Kyrgyzstan – KGZ Madagascar – MDG Marshall Islands – MHL Mauritania – MRT North Korea – PRK Russia – RUS Tonga – TON Ukraine – UKR Bosnia and Herzegovina – BIH Cameroon – CMR Comoros – COM Iraq – IRQ Jordan – JOR Macedonia – MKD Sudan – SDN Belarus – BLR Bulgaria – BGR Djibouti – DJI Kazakhstan – KAZ Romania – ROU Zambia – ZMB