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Try out PMC Labs and tell us what you think. Learn More. Many skin and skin-related diseases affect the sexes unequally, with attendant implications for public health and resource allocation. To better evaluate the incidence of skin and skin-related diseases affecting males versus females, we reviewed published population-based epidemiology studies of skin disorders performed utilizing Rochester Epidemiology Project REP data. Many of the population-based sex-specific incidence rates of skin and skin-related diseases derived from the Rochester Epidemiology Project are strikingly different from those estimated elsewhere.
In general, females are more commonly affected by skin and skin-related diseases. The reasons for this imbalance remain to be determined and are likely multifactorial. Over the decades, interest is growing regarding sex differences in disease with respect to epidemiology, pathogenesis, clinical presentation, and response to treatment.
Certain skin and skin-related diseases show striking differences between sexes in incidence patterns a measure of new cases in a population over a given period. The reasons underlying sex-based disparity in the development of skin and skin-related diseases remain largely unknown but are likely multifactorial.
The REP is a unique records linkage research infrastructure system that has captured health care data on almost all residents of Olmsted County since described in detail elsewhere. In a manuscript, we summarized all incidence studies of skin and skin-related diseases derived from REP. We reviewed each article and identified those that described IRs of skin and skin-related diseases in Olmsted County.
We included incidence studies in which overall sex-specific IRs either were reported or could be calculated using data from the original publications. Studies reporting 10 or fewer cases females and males combined were excluded. We also reviewed the worldwide English-language literature to identify additional reports of overall sex-specific IRs for the entire study period using PubMed.
Studies reporting 10 or fewer cases men and women combined were again excluded. In a few reports, the overall sex-specific IR was calculated only for one sex; we included these studies in our analysis. If multiple non-REP studies on overall sex-specific IRs were available, a maximum of 5 references for each disease were included; however, for some diseases, only 1 additional study was identified. We did not identify any non-REP incidence studies that met our inclusion criteria for lentigo maligna, pityriasis rosea, lower-extremity cellulitis, herpes progenitalis, cutaneous nontuberculous mycobacterial infection, hidradenitis suppurativa, delusional infestation, erythromelalgia, and alopecia areata; specifically, overall sex-specific IRs for the entire study period were either not reported in the studies that we Black women sex in Bala United Kingdom find, or they could not be calculated because of insufficient data in the original articles.
Otherwise, for REP studies, we performed additional calculations using age- and sex-specific counts and IRs from the publications, assuming that the of cases followed a Poisson distribution. The skin and skin-related diseases were grouped as follows for both REP studies and non-REP studies: 1 skin cancer; 2 connective tissue diseases; 3 papulosquamous diseases including psoriatic arthritis [PsA] ; 4 skin infections; and 5 other skin diseases.
Table 1 summarizes data abstracted from each REP study. Females in Olmsted County were more affected by connective tissue diseases such as scleroderma, morphea, dermatomyositis DMpSS, systemic lupus erythematosus SLE; not in all studiespityriasis rosea, herpes progenitalis, condyloma acuminatum, hidradenitis suppurativa, herpes zoster except in childrenerythromelalgia, venous stasis syndrome, and venous ulcers.
Males were slightly more affected by psoriasis and PsA. Males and females were equally affected by cutaneous malignant melanoma CMMexcept for a ificantly higher incidence among females aged 18 to 39 years. Adapted from Andersen and Davis 6. Used with permission.
Table 2 summarizes data abstracted from each of the included non-REP studies. In general, females worldwide also were more affected by connective tissue diseases such as SLE, cutaneous LE, scleroderma or systemic sclerosispSS and DM DM was not in all studiesvenous leg ulcers only 1 study foundand herpes zoster except for a US study in which males were slightly more affected.
Males worldwide seemed to be more commonly affected by basal cell carcinoma and squamous cell carcinoma. For cutaneous malignant melanoma, PsA, and condyloma acuminatum, the overall sex-specific IR varied by geographic area one sex was not predominant in all areas. We describe the of multiple population-based epidemiologic studies performed in Olmsted County, Minnesota, examining sex-based differences in disease IRs.
Intriguingly, most of the skin and skin-related diseases studied in Olmsted County were more common in females than males Figure. Others have also noted sex-based disparities in the overall IRs of skin and skin-related diseases worldwide Table 2.
The reasons underlying sex-based disparities in the incidence of skin and skin-related diseases remain largely unknown but are likely multifactorial. A, Skin cancer. B, Connective tissue diseases. C, Papulosquamous diseases including psoriatic arthritis. D, Skin infections. E, Other skin diseases. A direct comparison of the overall sex-specific IR data derived from the REP with data from other sources could, however, be complicated by several factors such as type of study eg, population-based, surveydifferences in the methods of disease ascertainment eg, diagnostic classification criteria vs self-reportedwhether the sex-specific IR was crude or standardized, or the age groups studied eg, all ages, adults only, children only.
The incidence of basal cell carcinoma was higher in males than females in Olmsted County, except for females 40 years or younger 89 ; the same was true for squamous cell carcinoma in Olmsted County. The incidence of lentigo maligna, a rare form of malignant melanoma in situ, is higher in males than females in Olmsted County.
In Olmsted County, females aged 18 to 39 years had a ificantly higher incidence of cutaneous malignant melanoma than males, 14 but when considering all ages combined, as well as patients aged 40 to 60 years, males and females were equally affected by cutaneous malignant melanoma.
The incidence of lupus was higher in females than males in Olmsted County, 162122 although this difference was not statistically ificant for combined SLE and discoid SLE. Other studies have also shown that females had a ificantly greater risk than males of acquiring SLE 55 — 58 and cutaneous LE. The incidence of scleroderma in Olmsted County is higher in females than in males for both localized scleroderma morphea and diffuse scleroderma systemic sclerosis.
The incidence of DM is higher in females than males in Olmsted County. The incidence of pSS was higher in females than males. In Olmsted County, white females were 13 times more affected by pSS than males. The incidence of psoriasis was similar between males and females in Olmsted County, 2527 but from tomales had a higher incidence of psoriasis, except for during the sixth decade of life. The incidence of PsA was higher in males than females in Olmsted County, 28 except from towhen females and males were equally affected.
The incidence of lower-extremity cellulitis in Olmsted County showed that females were slightly more affected compared with males. In Olmsted County, the incidence of delusional infestation was higher in females than males, although this difference was not statistically ificant. The strengths of studies using REP data are the availability of complete medical records since the date the REP started and the ability to examine trends in the incidence of diseases using consistent eligibility criteria. We acknowledge, however, that each of the included REP studies had potential limitations described in detail in the original publications.
A direct comparison of REP vs non-REP studies was complicated by differences in the types of studies performed population-based, survey, etc. Other limitations could be due to differences in sample sizes and age distributions. Some studies did not provide standardized rates but considered crude rates only.
It is unclear whether the would have been the same if all studies were assessed using standardized rates or crude rates and same methods.
We describe the of multiple population-based epidemiologic studies performed in Olmsted County, Minnesota, particularly examining sex-based differences in the incidence of skin and skin-related diseases. We observed notable differences between sexes in incidence patterns.
Despite methodologic limitations, we showed that females were more commonly affected by skin and skin-related diseases in Olmsted County and worldwide.
To further elucidate the global sex disparities in incidence of skin and skin-related diseases, more studies are needed, particularly from regions not represented well in the dermatology literature such as Latin America and Africa. A better insight into sex-based disparities may also facilitate better development for diagnosis, therapy, and prevention of these diseases in the future. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We acknowledge Jill M.
Killian and Amy L. Weaver for their assistance with statistical review and analysis of the data. National Center for Biotechnology InformationU. Int J Dermatol. Author manuscript; available in PMC Sep 1. Louise K. AndersenMD and Mark D. DavisMD. Author information Copyright and information Disclaimer. Reprints: Mark D. Copyright notice. The publisher's final edited version of this article is available at Int J Dermatol.
See other articles in PMC that cite the published article. Abstract Many skin and skin-related diseases affect the sexes unequally, with attendant implications for public health and resource allocation. Keywords: diseases of women, epidemiology, medical statistics, skin diseases.Black women sex in Bala United Kingdom
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