Skin Disorders the Number One Reason for Medical Visits in the United States

Important drivers of healthcare costs and utilization
Payer Perspectives in Dermatology
Caroline Helwick

A new study from the Mayo Clinic highlights the general public’s concern about skin conditions as the most common reason to visit a physician in the United States.

In the article, “Why Patients Visit Their Doctors: Assessing the Most Prevalent Conditions in a Defined American Population,” researchers from the Mayo Clinic conducted an extensive review of a large database and reached a rather unpredictable conclusion—more patients seek medical help for skin disorders than for back pain, colds, arthritis, and other common ailments (St Sauver JL, et al. Mayo Clin Proc. 2013;88:56-67).

Chronic diseases account for the majority of healthcare utilization and costs among adult Americans, but other types of nonacute conditions that have less serious long-term complications affect an even larger segment of the US population, and therefore account for significant resource utilization, the researchers noted. They were surprised to find that the most prevalent nonacute conditions are not chronic conditions that are related to aging (eg, diabetes, heart disease), but are instead conditions that affect men and women equally at all age-groups.

These disorders include, in this order, skin disorders, osteoarthritis and joint disorders, back problems, lipid disorders, and upper respiratory tract disease (excluding asthma). The wide range of disease states examined in the study helps to outline the key healthcare utilization drivers and patterns that may otherwise be disregarded.

Skin Disorders the Number One Medical Concern
The goal of the study was to identify the prevalence of the most common nonacute conditions among a population representative of the US population, using the resources of the Rochester Epidemiology Project, which links data on healthcare delivered to residents of Olmsted County, MN. The Mayo Clinic and its affiliated hospitals provide the majority of that care. The study captured data for 142,377 Olmsted County adult residents in 2009 who gave their consent for their data to be analyzed.

The analysis showed that skin disorders were the most prevalent condition in this general population. “Unexpectedly, almost half of the Olmsted County population of all ages received a diagnosis of skin disorders within approximately 5 years,” the investigators reported. At least 1 International Classification of Diseases, Ninth Revision (ICD-9) code for a skin condition was noted for 42.7% of the study group within the past 5 years. The category of skin disorders included 19 various ICD-9 conditions. Although none of the skin disorders alone was very common, in combination, skin disorders affected a significant proportion of individuals in all age-groups in Olmsted County.

“Skin disorders are not typically major drivers of disability or death but may be important determinants of healthcare utilization and cost,” the researchers wrote. They noted that many dermatologic conditions require continued follow-up and treatment.

When grouped according to age, skin disorders were the most prevalent (32.9%) for the youngest age-group (ie, newborn-18 years) in both sexes. This frequency steadily rose across the life span—38.2% for the 19 to 29 years age-group (of these, 43.4% were women), 41.3% for the 30 to 49 years age-group (48.5% women), 50.4% for the group aged 50 to 64 years (54.8%), and 65.7% for patients aged ≥65 years, when men and women reported the same frequency.

Other Common Conditions
Skin disorders were followed in frequency by osteoarthritis and joint disorders (33.6%), back problems (23.9%), disorders of lipid metabolism (22.4%), and upper respiratory tract disease (22.1%).

Among patients aged ≥65 years (70.7%), hypertension was the most prevalent condition, followed by lipid disorders and then skin disorders. The prevalence of the top 10 disease groups also differed by ethnic group. White persons had a higher prevalence of skin disorders than black or Asian individuals.

A Call to Action
Discussing the implications of these surprising findings, the investigators concluded, “Finding that skin and back problems are major drivers of healthcare utilization affirms the importance of moving beyond the commonly recognized health care priorities....Our findings highlight opportunities to improve healthcare and decrease costs related to common nonacute conditions as we move forward through the changing healthcare landscape.”

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Last modified: December 6, 2013
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