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KEY POINTS
The epidemiology of a cutaneous disease can be expressed using the following four standard measurements: mortality, incidence, prevalence, and utilization of healthcare services.
Commonly used racial classification systems lack biological validity, are inherently racist, and can be misleading.
The incidence and mortality of melanoma are lower in people with skin of color.
Data indicate that different racial groups seek treatment for different dermatologic disorders.
Establishing a rapport and channels of honest communication with patients is more important in healthcare than pigeonholing patients into racial categories.
Every patient deserves culturally competent care.
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THE EPIDEMIOLOGY OF CUTANEOUS DISEASES
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Cutaneous diseases—otherwise known as diseases of the skin—are very common. They can cause morbidity and have a significant impact on quality of life. With a few notable exceptions (eg, melanoma, toxic epidermal necrolysis, cutaneous T-cell lymphoma, and autoimmune bullous diseases), deaths from skin diseases are uncommon. This chapter will review the data on the descriptive epidemiology of cutaneous diseases using four commonly used measures: mortality, incidence, prevalence, and utilization of healthcare services.
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The term mortality is used to indicate the number of deaths from a specific disease occurring in a population over a defined period of time. The incidence of a disease is the number of new cases occurring in a population over a defined period of time. Incidence and mortality are commonly expressed as numbers of cases or deaths, respectively, per 100,000 people per year. Accurate incidence and mortality data can be obtained only if cases or deaths are reliably identified and reported. It is mandatory to report a death and the cause of death in the United States. Therefore, fairly accurate estimates of mortality rates for skin diseases are available. In the United States, accurate incidence data for skin diseases are available only for a few diseases, including melanoma, nonmelanoma skin cancer, Kaposi sarcoma, and cutaneous T-cell lymphoma.
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The prevalence of a disease is the number of cases in a population at a given time. It is a “snapshot” of the frequency at which a disease is present in a given population at a given time. Prevalence is best determined by performing a randomized survey of the population. Health-care service utilization can be measured by determining the number of visits to physicians over a defined period of time for specific reasons (for instance, by looking at diagnoses or complaints). Such information can be obtained from data collected for other purposes (often in billing records or drug dispensations), or it can be obtained specifically to study resource utilization. To understand the data on the epidemiology of skin diseases in people with skin of color, the problems that arise from attempts to racially classify human populations must be addressed.
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RACIAL CLASSIFICATION SYSTEMS: INHERENTLY RACIST AND LACKING BIOLOGICAL VALIDITY
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The first scientific attempt to classify human populations into races in 1735 was ...