Severity of skin disease linked to socioeconomic status

LOW income is associated with increased severity in a range of skin conditions, including psoriasis and melanoma, according to a paper recently presented at the annual meeting of the British Association of Dermatologists.

Researchers from Betsi Cadwaladr University Health Board examined sources from meta-analysis and reviews to analyse the link between socioeconomic factors and the severity and incidence rate of various dermatological conditions.

The analysis found that socioeconomic factors impact the severity of inflammatory skin conditions, such as atopic eczema and psoriasis. A review using the Global Burden of Disease study data found that the incidence of psoriasis is greater in high-income European countries but lower household income is linked to more clinically severe psoriasis cases. Patients that have a low socioeconomic status also have a higher impairment to their health-related quality of life than those from a high-income household.

A 2018 US survey of 2,137 patients with childhood-onset atopic eczema found that education levels were inversely associated with the severity of a patient’s eczema, and a higher concentration of children suffering with severe eczema lived in unsafe, unsupportive, or underdeveloped neighbourhoods.

Melanoma incidence was found to be increased in individuals with a higher socioeconomic status but poor prognosis was associated with a lower socioeconomic status.

Dr Siwaporn Hiranput, Dermatology specialist registrar at Glan Clwyd hospital, North Wales deanery said: "The data from this study gives robust evidence that while skin disease can affect all members of society, the burden of diseases do not fall equally. Consistently, the most deprived in society tend to face more severe disease. We want to emphasise the importance of socioeconomic factors in patients with common skin conditions."

Harriet Dalwood of the British Association of Dermatologists, commented: "It is really important to have research which clearly demonstrates health inequalities amongst people with skin disease. We know that melanoma is a disease which disproportionately affects the more advantaged in society, but it is less well recognised that that the severity of the disease tends to be worse amongst those with lower socioeconomic status. Health inequalities such as these are not just a health issue, they require joined-up thinking across government supported by organisations across the country."