National, regional, and worldwide epidemiology of psoriasis: systematic analysis and modelling study

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Abstract

Objective

To systematically review and provide information on the incidence of psoriasis and quantify global, regional, and country specific estimates of its prevalence.

Design

Systematic review and meta-analysis.

Data sources

Medline, Embase, Web of Science, SciELO, Korean Journal Databases, Russian Science Citation Index, WPRIM, SaudiMedLit, Informit, IndMed, and HERDIN were searched systematically from their inception dates to October 2019.

Methods

Studies were included if they reported on the incidence or prevalence of psoriasis in the general population. Incidence data were summarised descriptively, whereas bayesian hierarchical models were fitted to estimate the global, regional, and country specific prevalence of psoriasis.

Results

41 164 records were identified and 168 studies met the inclusion criteria. In adults, the incidence of psoriasis varied from 30.3 per 100 000 person years (95% confidence interval 26.6 to 34.1) in Taiwan to 321.0 per 100 000 person years in Italy. The prevalence of psoriasis varied from 0.14% (95% uncertainty interval 0.05% to 0.40%) in east Asia to 1.99% (0.64% to 6.60%) in Australasia. The prevalence of psoriasis was also high in western Europe (1.92%, 1.07% to 3.46%), central Europe (1.83%, 0.62% to 5.32%), North America (1.50%, 0.63% to 3.60%), and high income southern Latin America (1.10%, 0.36% to 2.96%).

Conclusions

Eighty one per cent of the countries of the world lack information on the epidemiology of psoriasis. The disease occurs more frequently in adults than in children. Psoriasis is unequally distributed across geographical regions; it is more frequent in high income countries and in regions with older populations. The estimates provided can help guide countries and the international community when making public health decisions on the appropriate management of psoriasis and assessing its natural history over time.

Systematic review registration

PROSPERO CRD42019160817.

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Most cited references 21

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Pathogenesis and clinical features of psoriasis.

Christopher EM Griffiths, Jonathan Barker (2007)

Psoriasis, a papulosquamous skin disease, was originally thought of as a disorder primarily of epidermal keratinocytes, but is now recognised as one of the commonest immune-mediated disorders. Tumour necrosis factor alpha, dendritic cells, and T-cells all contribute substantially to its pathogenesis. In early-onset psoriasis (beginning before age 40 years), carriage of HLA-Cw6 and environmental triggers, such as beta-haemolytic streptococcal infections, are major determinants of disease expression. Moreover, at least nine chromosomal psoriasis susceptibility loci have been identified. Several clinical phenotypes of psoriasis are recognised, with chronic plaque (psoriasis vulgaris) accounting for 90% of cases. Comorbidities of psoriasis are attracting interest, and include impairment of quality of life and associated depressive illness, cardiovascular disease, and a seronegative arthritis known as psoriatic arthritis. A more complete understanding of underlying pathomechanisms is leading to new treatments, which will be discussed in the second part of this Series.

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Is Open Access

Global Skin Disease Morbidity and Mortality : An Update From the Global Burden of Disease Study 2013

Chante Karimkhani, Robert Dellavalle, Luc E. Coffeng … (2017)

Question What is the burden of skin disease worldwide? Findings In this observational study, skin diseases contributed 1.79% to the global burden of disease measured in disability-adjusted life years (DALYs). Skin diseases arranged in order of decreasing global DALYs are as follows: dermatitis (atopic, contact, seborrheic), acne vulgaris, urticaria, psoriasis, viral skin diseases, fungal skin diseases, scabies, melanoma, pyoderma, cellulitis, keratinocyte carcinoma, decubitus ulcer, and alopecia areata. Meaning Skin diseases remain a major cause of disability worldwide. An objective measure of burden, such as the DALY, allows for comparison of diverse diseases across geography and time. This study measures the burden of skin diseases worldwide. Importance Disability secondary to skin conditions is substantial worldwide. The Global Burden of Disease Study 2013 includes estimates of global morbidity and mortality due to skin diseases. Objective To measure the burden of skin diseases worldwide. Data Sources For nonfatal estimates, data were found by literature search using PubMed and Google Scholar in English and Spanish for years 1980 through 2013 and by accessing administrative data on hospital inpatient and outpatient episodes. Data for fatal estimates were based on vital registration and verbal autopsy data. Study Selection Skin disease data were extracted from more than 4000 sources including systematic reviews, surveys, population-based disease registries, hospital inpatient data, outpatient data, cohort studies, and autopsy data. Data metrics included incidence, prevalence, remission, duration, severity, deaths, and mortality risk. Data Extraction and Synthesis Data were extracted by age, time period, case definitions, and other study characteristics. Data points were modeled with Bayesian meta-regression to generate estimates of morbidity and mortality metrics for skin diseases. All estimates were made with 95% uncertainty intervals. Main Outcomes and Measures Disability-adjusted life years (DALYs), years lived with disability, and years of life lost from 15 skin conditions in 188 countries. Results Skin conditions contributed 1.79% to the global burden of disease measured in DALYs from 306 diseases and injuries in 2013. Individual skin diseases varied in size from 0.38% of total burden for dermatitis (atopic, contact, and seborrheic dermatitis), 0.29% for acne vulgaris, 0.19% for psoriasis, 0.19% for urticaria, 0.16% for viral skin diseases, 0.15% for fungal skin diseases, 0.07% for scabies, 0.06% for malignant skin melanoma, 0.05% for pyoderma, 0.04% for cellulitis, 0.03% for keratinocyte carcinoma, 0.03% for decubitus ulcer, and 0.01% for alopecia areata. All other skin and subcutaneous diseases composed 0.12% of total DALYs. Conclusions and Relevance Skin and subcutaneous diseases were the 18th leading cause of global DALYs in Global Burden of Disease 2013. Excluding mortality, skin diseases were the fourth leading cause of disability worldwide.

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Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction.

Robert S Stern, Tamar Nijsten, David J Margolis … (2004)

The impact of psoriasis on quality of life has been studied in select patient populations. Population-based data detailing the distribution of extent of disease, associated problems in everyday life, and treatment satisfaction for the US population have been lacking. Our population-based survey indicates that approximately 4.5 million adults have been diagnosed as having psoriasis. Most (59%) have little or no involvement, but 650,000 adults have at least three palms of body surface involved and more than 1,000,000 indicate substantial dissatisfaction with their treatment. Only 5% of patients (56,000) who report severe dissatisfaction with current therapy have extensive disease (10 palms). Many individuals with little psoriasis at the time of interview considered the disease to be a large problem in everyday life.

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Author and article information

Contributors

Rosa Parisi:

ORCID: http://orcid.org/0000-0002-0968-9153

Role: research fellow

Ireny Y K Iskandar: Role: research associate

Evangelos Kontopantelis: Role: professor

Matthias Augustin: Role: professor

Christopher E M Griffiths: Role: professor

Darren M Ashcroft: Role: professor

Journal

Journal ID (nlm-ta): BMJ

Journal ID (iso-abbrev): BMJ

Journal ID (publisher-id): BMJ-UK

Journal ID (hwp): bmj

Title: The BMJ

Publisher: BMJ Publishing Group Ltd.

ISSN (Print): 0959-8138

ISSN (Electronic): 1756-1833

Publication date Collection: 2020

Publication date (Electronic): 28 May 2020

Volume: 369

Electronic Location Identifier: m1590

Affiliations

[1 ]Division of Pharmacy and Optometry, University of Manchester, Manchester, UK

[2 ]Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK

[3 ]Institute of Health Care Research in Dermatology and Nursing, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

[4 ]Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, UK

[5 ]NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK

Author notes

Correspondence to: R Parisi, Division of Informatics, Imaging & Data Sciences, School of Health Sciences, University of Manchester, Manchester M13 9PT, UK rosa.parisi@ 123456manchester.ac.uk (or @RosaParisi09 on Twitter)

Author information

Rosa Parisi http://orcid.org/0000-0002-0968-9153

Article

Publisher ID: parr052230

DOI: 10.1136/bmj.m1590

PMC ID: 7254147

PubMed ID: 32467098

SO-VID: e60c4460-1805-4eb3-8bfe-84c33f4d2701

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

National, regional, and worldwide epidemiology of psoriasis: systematic analysis and modelling study

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Systematic review registration

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Most cited references 21

Pathogenesis and clinical features of psoriasis.

Global Skin Disease Morbidity and Mortality : An Update From the Global Burden of Disease Study 2013

Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction.

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