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Minimal changes in the evolution of global burden of skin disease

In 2016 was released a global analysis on the evolution of global burden ok skin disease in the Journal of the American Academy of Dermatology (JAAD), presenting data from 187 countries. What are the dominant facts observed in this study ?

Carried out by dermatologists from Colorado and North Dakota universities, the survey named "Minimal improvements in the global burden of skin disease" deals with the evolution of skin disease burden from 1990 to 2013 through 187 states. This assessment is all the more essential as skin diseases is the fourth cause of nonfatal disease burden worldwide.

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Method : an approach based on the number of years each patients lives with a disease

So as to concretely measure the notion of "burden", the researchers used the YLD indicator ("years lived with disability") which help estimate the average number of years people suffer from a non-fatal disease. These data have been collected thanks to the reports elaborated by the Institute for Health Metrics and Evaluation. The achieved results were divided into two categories: "developed countries" and "developing countries" as defined by the human development index (IDH).

Developed countries : a sligthly positive result

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The graph above shows the evolutions of different countries according to the DALY indicator ("Disability-Adjusted Life Year", directly linked to YLD) calculated by estimating "healthy" years lost because of a mortal or a non-fatal disease. 30 out of 47 countries categorised as "developed" show a DALY decrease in the field of dermatology, among which Portugal (9%), Israel (8%), Spain (8%), Czech Republic (7%) and Hungary (7%) are the best examples. However, the situation stagnated in 6 countries, including Japan and Australia. Last , 11 countries have been affected by a rise of skin disease burden, first and foremost Middle East countries such as Qatar (8%), Bahrain (6%) and United Arab Emirates (5%). Next are, amongst others, Chile (4%), Argentina (3%), Saudi Arabia (3%), Belgium (2%) and Norway (2%).

Developing countries : modest and minority improvements

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Among 140 countries making up the "developing countries" category, only 26 have showed a positive evolution. Serbia, Gambia and Kenya are part of the most noticeable cases of DALY decrease (5 %). Set aside 10 countries where no change has been observed, 104 remaining countries have been affected by substantial DALY increases. Some of these latter are, in descending order, Palestine (15%), Nicaragua (11%), Oman (11%), Cape Verde(10%), Bangladesh (10%), Nepal (10%) and Yemen (10%).

Results interpretation and limitations

According to the researchers, two conclusions follow the results. First, most of world countries, both developed and developing, have experienced little or no improvement in disability caused by skin diseases. Then, the assumption that increase in life expectancy could be an explanation to this first conclusion for developed countries cannot be valid. Indeed, developing countries show similar results in this global study while undergoing weaker increases in this area.

It also should be clarified that the study cannot avoid limitations in the matter of disease burden self-measurement, which can vary a lot depending on different cultural and economic contexts. In developed countries, for instance, patients expectations regarding their treatment may be much higher than that of their developing countries counterparts, partly as a result of pharmaceutical marketing. Unfortunately, these limits could not be taken into account in the Institute for Health Metrics and Evaluation reports.

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