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INVESTIGATIVE REPORT
Socioeconomic Status and the Prevalence of Skin and Atopic
Diseases in Five European Countries
Robert F. OFENLOCH 1 , Marie Louise A. SCHUTTELAAR 2 , Åke SVENSSON 3 , Magnus BRUZE 4 , Luigi NALDI 5,6 , Simone
CAZZANIGA 5 , Peter ELSNER 7 , Margarida GONCALO 8 and Thomas L. DIEPGEN 1
Department of Social Medicine, Occupational and Environmental Dermatology, University Hospital Heidelberg, Heidelberg, Germany,
Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands, 3 Department of
Dermatology and 4 Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden,
5
Centro Studi GISED – FROM Presidio Ospedaliero Matteo Rota, Bergamo, 6 Department of Dermatology, AULSS8 Berica, Ospedale San
Bortolo, Vicenza, Italy, 7 Department of Dermatology, University Hospital Jena, Jena, Germany, and 8 Department of Dermatology, Coimbra
University Hospital, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
1
2
The aim of this study was to investigate the associa-
tion between socioeconomic status and the prevalence
of self-reported skin and atopic diseases in the general
population of 5 European countries. A random sample
was drawn from the general population aged 18–74
years, based on electoral precincts. Socioeconomic
status was estimated by combining net household
income with the highest education of respondents. A
total of 7,904 subjects were included in this analysis.
The lifetime prevalence of “contact dermatitis” ranged
from 13.1% (95% confidence interval (95% CI 11.8–
14.4%) in subjects with low socioeconomic status, to
19.1% (95% CI 17.5–20.8%) in those with high socio
economic status. In younger subjects skin cancer was
more prevalent in the middle or high socioeconomic
status groups compared with the low socioeconomic
status group (odds ratio 2.4; 95% CI 1.4–4.3); how
ever, this effect was not found in elderly subjects. The
lifetime prevalence for at least one atopic disease was
61.2% (95% CI 59.4–63.0%) in the low and 82.8%
(95% CI 81.1–84.3%) in the high socioeconomic sta-
tus group. Individuals with middle or high socioeco-
nomic status reported an overall higher prevalence of
skin and atopic diseases compared with those with low
socioeconomic status. These findings may reflect diffe-
rences in reporting, which are likely to result in an un-
derdiagnoses, especially for skin cancer in the younger
age groups with low socioeconomic status.
Key words: socioeconomic status; health inequalities; preva-
lence; skin diseases; European population.
Accepted Nov 14, 2018; E-published Nov 14, 2018
Acta Derm Venereol 2019; 99: 309–314.
Corr: Robert Ofenloch, Department of Social Medicine, Occupational
and Environmental Dermatology, University Hospital Heidelberg, Voßstr.
2, DE-69115 Heidelberg, Germany. E-mail: [email protected]
heidelberg.de
T
he association between socioeconomic status (SES)
and health state is well known and has been studied
intensively with widely corresponding results: people
with low SES (i.e. low income and/or low education),
in general, have a worse health status compared with
individuals with middle or high SES (1). A spread in
life expectancy of up to 20 years can be seen among
SIGNIFICANCE
People living within a low socioeconomic status usually
show a lower health status compared to subjects with high
socioeconomic status. They are more often sick, diseases
show a more severe course and life expectancy is redu-
ced. We analyzed this health inequality for skin and atopic
diseases in a sample of the general European population
and found quite the contrary: people with high socioeco-
nomic status reported more skin diseases. However, we
argue that this is an issue of underreporting – in conse-
quence preventive programs should aim at strengthening
screening approaches for skin diseases in people with low
socioeconomic status.
countries as well as within countries between the dif-
ferent socioeconomic groups (2). Recently, Elgar et al.
(3) found an increase in health inequalities in adoles-
cents between 2002 and 2010 by analysing time-series
data from 34 countries. However, for skin diseases the
situation appears to be different, and there are a couple
of studies with contradicting results: an early study on
this topic performed in a UK population showed that
childhood eczema is more prevalent in higher social
classes, and this was true for self-reported as well as for
diagnosed eczema (4). In the UK cancer registry rates
for all types of skin cancer have been found to be higher
in individuals with high SES (5, 6). This finding led
to the conclusion that skin cancer cannot be attributed
primarily to exposure to sunlight, since individuals with
low SES are more likely to work in the sun and would
therefore show higher incidence rates (6). However, in
other studies occupational exposure to sunlight is clearly
associated with skin cancer and differences in skin cancer
mortality cannot be found between SES groups (7). In
addition, the prevalence of actinic keratosis was found to
be higher in individuals with low SES in a representative
Italian sample investigated by trained interviewers using
a photographic guide (8).
In the Netherlands no associations between SES
and chronic eczema or psoriasis (9) were diagnosed in
consecutive samples of patients from general practices.
Another Dutch study showed that high SES was asso-
ciated with a higher incidence of basal cell carcinoma
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2019 Acta Dermato-Venereologica.
doi: 10.2340/00015555-3082
Acta Derm Venereol 2019; 99: 309–314