Epidemiology of skin diseases in Germany: systematic review of the current state of research - part 1: cutaneous tumor diseases

Evaluation der Hautkrebsfrüherkennung in Deutschland - Teilnahme, Tumordetektion und Intervalltumoren auf Grundlage von GKV-Daten

Hintergrund und Ziele

Die steigende Hautkrebshäufigkeit in Deutschland hat den Bedarf an sekundärpräventiven Maßnahmen erhöht. Hierfür wurde zum 01.07.2008 ein gesetzliches Hautkrebsscreening für Versicherte ab 35 Jahren eingeführt. Ziel dieses Arbeitspakets im Innovationsfonds‐Projekt „Perspektiven einer multimodalen Evaluation der Hautkrebsfrüherkennung“ (Pertimo) war die Erprobung einer Evaluation des Hautkrebsscreenings anhand von Sekundärdaten.

Patienten und Methodik

Datengrundlage waren gesetzlich Versicherte der DAK‐Gesundheit ab 35 Jahren, die zum 31.12.2010 versichert waren und bis Ende 2015 nachbeobachtet wurden. Die Raten der Teilnahme sowie der im Hautkrebsscreening entdeckten Hauttumoren (Tumordetektionen) und der Intervalltumoren, welche innerhalb von zwei Jahren nach einem befundfreien Hautkrebsscreening auftraten, wurden berechnet.

Ergebnisse

Die zweijährliche Hautkrebsscreening‐Inanspruchnahmerate in 2014 und 2015 lag bei Frauen bei 33,6% und bei Männern bei 32,6%. Von den Gescreenten hatten 4,2% im Zuge des Hautkrebsscreenings einen Hautkrebsbefund (Tumordetektion). Von allen inzidenten Hautkrebsdiagnosen (2012–2015) wurden 50,1% im Hautkrebsscreening entdeckt. Bei 1,5% der Versicherten mit Hautkrebsscreening ohne Befund wurde in den folgenden zwei Jahren ein inzidenter Hauttumor diagnostiziert (Intervalltumor).

Schlussfolgerungen

Die Daten der gesetzlichen Krankenversicherung bildeten das Hautkrebsscreening‐Geschehen in Deutschland ab und verdeutlichten die Wichtigkeit von Dermatologen im Screeningprozess. Die Analyse lieferte wichtige neue Erkenntnisse.

Evaluation of skin cancer screening in Germany - participation, tumor detection and interval tumors based on SHI data

BACKGROUND AND GOALS

The rising incidence of skin cancer in Germany has increased the need for secondary prevention measures. For this purpose, a statutory skin cancer screening for insured persons aged 35 and older was introduced on 1 June 2008. The aim of this work package in the Innovation Fund project "Perspectives of a multimodal evaluation of early skin cancer detection" (Pertimo) was to test an evaluation of skin cancer screening using secondary data.

PATIENTS AND METHODS

The data basis was statutory insured persons of the DAK Health from the age of 35 who were insured as of 31 December 2010 and were followed up until the end of 2015. The rates of participation, skin tumors detected in skin cancer screening (tumor detections), and interval tumors that occurred within two years after a finding-free skin cancer screening were calculated.

RESULTS

The biennial skin cancer screening take-up rate in 2014 and 2015 was 33.6% for women and 32.6% for men. Of those screened, 4.2% had a skin cancer finding (tumor detection) in the course of skin cancer screening. Of all incident skin cancer diagnoses (2012-2015), 50.1% were detected in skin cancer screening. In 1.5% of the insured persons with skin cancer screening without findings, an incidental skin tumor was diagnosed in the following two years (interval tumor).

CONCLUSIONS

The data from the statutory health insurance mapped the skin cancer screening occurrence in Germany and highlighted the importance of dermatologists in the screening process. The analysis provided important new insights.

Characterization of patients with psoriatic arthritis in dermatologic and rheumatologic care: analysis of two registries

BACKGROUND AND OBJECTIVE

Psoriatic arthritis (PsA) is a chronic systemic inflammatory disease affecting the musculoskeletal system, skin and nails. The aim is to characterize sociodemographic and clinical patient profiles documented in dermatologic and rheumatologic care.

PATIENTS AND METHODS

Data of 704 patients with PsA from the dermatological Psoriasis Registry PsoBest (PB) and 1066 patients from the rheumatological disease registry RABBIT-SpA (RS) were analyzed. Comparable anamnestic and clinical variables were identified and descriptively analyzed.

RESULTS

The mean age was 51.7 years in PB and 51.9 in RS. Disease duration of psoriasis was longer, mean cutaneous severity was higher in PB. However, more patients in RS vs. PB had tender joints and swollen joints. Mean Dermatology Life Quality Index was higher in PB and mean Health Assessment Questionnaire in RS. Patient reported global disease activity and pain were lower in PB. IL-23 inhibitors were used more frequently in PB, and TNF inhibitors in RS.

CONCLUSIONS

Clinical specialization was associated with different clinical and treatment patterns of PsA. This may indicate a selection by dominant manifestation of psoriatic disease and potentially by effects of health care access. Psoriatic arthritis should be treated in a multidisciplinary approach considering all facets of this complex disease.

Charakterisierung von Patienten mit Psoriasisarthritis in der dermatologischen und rheumatologischen Versorgung: Analyse von zwei Registern: Characterization of patients with psoriatic arthritis in dermatologic and rheumatologic care: analysis of two registries

Hintergrund und Zielsetzung

Die Psoriasisarthritis (PsA) ist eine chronische systemische Entzündungskrankheit, die den Bewegungsapparat, die Haut und die Nägel betrifft. Ziel ist es, soziodemografische und klinische Patientenprofile zu charakterisieren, die in der dermatologischen und rheumatologischen Versorgung dokumentiert werden.

Patienten und Methodik

Es wurden die Daten von 704 PsA‐Patienten aus dem dermatologischen Psoriasis‐Register PsoBest (PB) und 1066 Patienten aus dem rheumatologischen Krankheitsregister RABBIT‐SpA (RS) analysiert. Vergleichbare anamnestische und klinische Variablen wurden identifiziert und deskriptiv ausgewertet.

Ergebnisse

Das Durchschnittsalter betrug 51,7 Jahre bei PB und 51,9 Jahre bei RS. Die Krankheitsdauer der Psoriasis war länger und der mittlere Schweregrad der Hauterkrankung war bei den Patienten in PB höher, jedoch hatten mehr Patienten in RS schmerzende und geschwollene Gelenke. Der mittlere Dermatology Life Quality Index war bei den Patienten in PB höher und der mittlere Health Assessment Questionnaire bei den Patienten in RS. Die von den Patienten angegebene globale Krankheitsaktivität und die Schmerzen waren in PB geringer. IL‐23‐Inhibitoren wurden in PB häufiger eingesetzt, TNF‐Inhibitoren bei RS.

Schlussfolgerungen

Die klinische Spezialisierung wurde mit unterschiedlichen Krankheitsbildern und Behandlungsmustern der PsA in Verbindung gebracht. Dies könnte auf eine Selektion nach der vorherrschenden Manifestation der Psoriasis‐Erkrankung und möglicherweise auf Auswirkungen des Zugangs zur Gesundheitsversorgung hinweisen. Die PsA sollte in einem multidisziplinären Ansatz behandelt werden, der alle Facetten dieser komplexen Erkrankung berücksichtigt.

[Shaded places for skin cancer prevention in kindergartens and schools]

BACKGROUND

Excessive UV radiation from the sun may lead to skin cancer, the most common type of cancer in Germany. Therefore, among other things, the World Health Organization recommends seeking shade during the midday hours from a UV index of 3 (3 to 5 = "moderate"). However, this important preventive measure can only be taken if sufficient shaded areas are available. The aim of the study is to record shaded areas in kindergartens and schools nationwide.

METHODS

An epidemiological cross-sectional study with two samples was carried out. Management of kindergartens and schools were surveyed using online questionnaires about the provision of shading measures at their educational institution from May to August 2020 and from April to July 2021, respectively. The primary outcome was to record the presence of various structural shading measures in the outdoor area of their educational institutions. The secondary outcome was to estimate the size of the shaded exterior area.

RESULTS

From the nationwide population, 1042 kindergartens (1.9%) and 713 schools (2.3%) participated. Compared to schools, kindergartens had sun protection measures in the outdoor area significantly more often (99% vs. 82%; p < 0.001) and were able to shade a significantly larger outdoor area (43% vs. 26%; p < 0.001). Assuming a minimum required shaded outdoor area of 1 m2 per person, 45% of the schools and 10% of the kindergartens did not have sufficient shaded outdoor areas (p < 0.001).

CONCLUSION

Almost every fifth school in Germany had no shaded places in the outdoor area. Against the background of climatic changes, an urgent high need for improvements seems obvious.

Epidemiology of skin diseases in Germany: systematic review of the current state of research - part 2: non-infectious skin diseases

The aim of this work was to systematically collect all previously published population-based epidemiological data on skin diseases in Germany. The present part 2 of the publication series deals with non-infectious skin diseases. The results on cutaneous tumor diseases (part 1) and infectious skin diseases (part 3) form the other parts of this publication series. A systematic literature search was performed using PubMed/MEDLINE for the period of the last 15 years. With the aim of including all dermatologic diseases, a diagnostic list was developed based on the ICD-11 catalogue. This list included 1,347 skin diseases and formed the basis for the search. The literature search yielded 4,650 hits, of which 72 were included in the synthesis. Among them were 37 publications on non-infectious skin diseases. Among these, psoriasis and atopic eczema were the most common. The highest lifetime prevalence was found for acne. This work is the first systematic literature review that aimed to report all available epidemiological data on skin diseases in Germany. It was found that representative data on many non-infectious diseases are not yet available. Among the included studies, there was a high heterogeneity regarding the methodology. Nevertheless, the utility of these epidemiological data is wide-ranging and can serve as a reference of various epidemiological questions.

Epidemiology of skin diseases in Germany: systematic review of the current state of research - part 3: infectious skin diseases

The aim of this work was to systematically collect all previously published population-based epidemiological data on skin diseases in Germany. A systematic literature search was performed using PubMed/MEDLINE for the period of the last 15 years. With the aim to include all dermatological diseases, a diagnostic list based on the ICD-11 catalogue was compiled. This list included 1,347 skin diseases and formed the basis for the search. The present part 3 of the publication series deals with infectious skin diseases. The results on cutaneous tumor diseases (part 1) and non-infectious skin diseases (part 2) form the other parts of this publication series. The literature search yielded 4,605 hits, of which 72 papers on 43 different skin diseases were included in the synthesis. Among them were twelve hits on infectious dermatoses, of which six papers were related to measles. The highest lifetime prevalence rates were found for varicella and verrucae vulgaris. This work is the first systematic literature review that aimed to report all available epidemiological data on skin diseases in Germany. It was found that representative data on many infectious diseases are not yet available. Among the included studies, a high heterogeneity was found with regard to the methodology. Nevertheless, these epidemiological data have a wide range of uses and can serve as a reference for various epidemiological questions.