Global burden of urticaria: Insights from the 2016 Global Burden of Disease Study
Authors: Elena Maxim, Chante Aksut, Derrick Tsoi, Robert Dellavalle
Journal: Journal of the American Academy of Dermatology (2018)

To the Editor: Urticaria can be associated with significant functional impairment.1Maurer M. Abuzakouk M. Bérard F. et al.The burden of chronic spontaneous urticaria is substantial: real-world evidence from ASSURE-CSU.Allergy. 2017; 72: 2005-2016Crossref PubMed Scopus (95) Google Scholar While prevalence studies exist, few have explored the burden of urticaria worldwide, and to understand how a disease contributes to morbidity and mortality, measures beyond prevalence and incidence should be considered. The Global Burden of Disease (GBD) Study is a systematic, comprehensive effort to estimate the comparative magnitude of premature death and disability in >195 countries and 300 diseases.2Institute for Health Metrics and Evaluation (IHME)GBD Compare. IHME, University of Washington, Seattle, WA2016http://vizhub.healthdata.org/gbd-compareGoogle Scholar To our knowledge, this study is the first effort to present GBD results regarding the burden of urticaria by age, sex, and geography. Complete details of GBD methodology are available elsewhere.3Karimkhani C. Dellavalle R.P. Coffeng L.E. et al.Global skin disease morbidity and mortality: an update from the Global Burden of Disease study 2013.JAMA Dermatol. 2017; 153: 406-412Crossref PubMed Scopus (220) Google Scholar Methods specific to the estimation of urticaria burden are presented here. A systematic review was performed on PubMed and Google Scholar to capture epidemiologic data for urticaria, including studies published during 1980-2014. Hospital outpatient and US claims data (using International Classification of Diseases, Tenth Revision, code L50) from 2000, 2010, and 2012 were also included. A Bayesian meta-regression tool, DisMod-MR 2.1, was used to model urticaria epidemiologic data points and estimate prevalence by age, sex, year, and country. Predictive covariates are used to create approximate estimates for countries lacking data. The GBD methods stratify disease-specific prevalence by severity level by assessing varying levels of itch, pain, and worry. Disability weights range from 0 (least disabling) to 1 (most disabling) and were derived from 4 population-based European surveys and an open-access web-based survey of 60,890 respondents.3Karimkhani C. Dellavalle R.P. Coffeng L.E. et al.Global skin disease morbidity and mortality: an update from the Global Burden of Disease study 2013.JAMA Dermatol. 2017; 153: 406-412Crossref PubMed Scopus (220) Google Scholar Disease burden is measured by disability-adjusted life years (DALYs), combining morbidity (years lost to disability) with mortality (life-years lost), such that 1 DALY is equivalent with 1 healthy life–year lost.3Karimkhani C. Dellavalle R.P. Coffeng L.E. et al.Global skin disease morbidity and mortality: an update from the Global Burden of Disease study 2013.JAMA Dermatol. 2017; 153: 406-412Crossref PubMed Scopus (220) Google Scholar The global age-standardized DALY rate for urticaria is 55.49/100,000 population. Among skin disease, the global burden from urticaria in 2016 ranks only behind acne vulgaris (214/100,000), dermatitis (152/100,000), viral skin disease (80.02/100,000) and psoriasis (76/100,000).2Institute for Health Metrics and Evaluation (IHME)GBD Compare. IHME, University of Washington, Seattle, WA2016http://vizhub.healthdata.org/gbd-compareGoogle Scholar The 3 world regions with the greatest DALY rates for urticaria are Central Europe (61.8/100,000 population), Eastern Europe (60.7/100,000 population), and Central Asia (60.6/100,000 population). Fig 1 depicts the urticaria DALY rate per country. The age-standardized DALY rate for urticaria is 47.4/100,000 population and 62.5/100,000 population in male and female persons, respectively. Analysis of urticarial burden of disease by age group shows that children aged 1-4 years have the highest burden of disease (164.02/100,000 population), followed by postnatal infants (129.98/100,000 persons) and those aged 5-9 years (85.06/100,000 population). Fig 2 depicts the DALY rate for the consecutive age categories studied.Fig 2Total mean estimates of DALYs lost for urticaria with 95% confidence intervals by consecutive age category. Age categories shown reflect incidence at each year of life. DALY, Disability-adjusted life years; EN, early neonatal; LN, late neonatal; PN, postnatal period or the first 6 weeks after birth.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Limitations of the GBD Studies have been previously described.4Vos T. Flaxman A.D. Naghavi M. et al.Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease study 2010.Lancet. 2012; 380: 2163-2196Abstract Full Text Full Text PDF PubMed Scopus (4796) Google Scholar Although the GBD model relies on high-quality analysis and statistics, it is not a perfect prediction model, and the data do not differentiate between chronic and acute episodes of urticaria. Despite the limitations, the GBD data offer a solid base for further studies to build upon. Targeted therapy (anti-IgE) for urticaria has a potential to decreased overall morbidity associated with the disease.5Büyüköztürk S. Gelincik A. Demirtürk M. Kocaturk E. Colakoğlu B. Dal M. Omalizumab markedly improves urticaria activity scores and quality of life scores in chronic spontaneous urticaria patients: a real life survey.J Dermatol. 2012; 39: 439-442Crossref PubMed Scopus (64) Google Scholar The data presented in this study highlight the variation in burden of disease by geography, sex, and age, which can be used to guide further research on targeted therapies, especially for populations heavily affected by urticaria.