Skin, subcutaneous disease rates varied across US states over time

Rates of skin and subcutaneous diseases varied greatly across U.S. regions and states, according to findings from a large analysis spanning data from nearly three decades.

“Skin and subcutaneous diseases affect the health of millions of individuals in the U.S.,” Melissa R. Laughter, PhD, of the department of dermatology at the University of Colorado School of Medicine, and colleagues wrote. “Data are needed that highlight the geographic trends and variations of skin disease burden across the country to guide health care decision-making.”

In the cohort study, the researchers analyzed findings from the Global Burden of Disease (GBD) database, which is comprised of more than 90,000 data sources including “systematic reviews, surveys, population-based disease registries, hospital inpatient and outpatient data, cohort studies and autopsy data,” according to the researchers.

With the aim of characterizing trends and variations in the burden of skin and subcutaneous tissue disorders in the U.S. between 1990 and 2017, they used the database to divide skin conditions into 15 subcategories. Incidence, prevalence, adequacy of data and standardized disease definitions comprised the subcategories.

Using data specifically from the 2017 GBD report, the researchers also assessed melanoma and keratinocyte carcinoma burden.

Age-standardized disability-adjusted life-years (DALYs) served as the primary endpoint. Incidence and prevalence of skin and subcutaneous disease also underwent analysis, along with stratification by state for the highest and lowest age-standardized DALY rate per 100,000 population.

Overall results from the 50 states plus the District of Columbia showed that age-standardized DALY rates increased from 821.6 (95% uncertainty interval [UI], 570.3-1124.9) in 1990 to 884.2 (95% UI, 614-1207.9) in 2017.

Over that time span, the largest increase in age-standardized DALY rate of skin and subcutaneous diseases was reported in New York, at 0.12% (95% UI, 0.09%-0.15%). The smallest increases in this outcome, at 0.04% each, were reported in four states: Colorado (95% UI, 0.02%-0.07%), Nevada (95% UI, 0.01%-0.06%), New Mexico (95% UI, 0.02%-0.07%) and Utah (95% UI, 0.02%-0.07%).

Data from 2017 specifically showed that New York topped the list for age-standardized DALY rate for skin and subcutaneous disease, at 1097 (95% UI, 764.9-1496.1). That same year, Wyoming reported the lowest number for this outcome (672.9; 95% UI, 465.6-922.3).

Other findings from the 50 states and the District of Columbia showed that the overall age-standardized DALY rate for skin and subcutaneous diseases was 971.2 (95% UI, 676.76-1334.59) among women but just 799.23 (95% UI, 559.62-1091.50) among men.

Conversely, DALY rates for malignant melanoma were elevated in men compared with women, 80.82 (95% UI, 51.68-123.18) vs. 42.74 (95% UI, 34.05-70.66). Similarly, keratinocyte carcinoma DALY rates also were higher in men (37.56; 95% UI, 29.35-49.52) compared with women (14.42; 95% UI, 10.01-20.66).

“Data from the GBD suggest that the burden of skin and subcutaneous disease was large and that DALY rate trends varied across the U.S.,” the researchers wrote. “The age-standardized DALY rate for keratinocyte carcinoma appeared greater in men. These findings can be used by states to target interventions and meet the needs of their population.”