India’s risk of NCDs is already on the rise – NCDs which would typically be present in people of 55 years of age and above in many developed countries are now witnessing their onset in India almost a decade earlier, at about 45 years of age.
By Maya Vedamurthy
Have you ever wondered what is the main cause of psoriasis? First, be aware that the recent global healthcare access and quality (HAQ) index, published in April this year showed India’s ranking improved from 153 in 1990 to 145 in 2016, as per IOSR Journal of Nursing and Health Science. However, on a global scale, India still stands lower than Bangladesh and even sub-Saharan Sudan and Equatorial Guinea. Rising changes in lifestyle has increased the disease burden in India, with Non-Communicable Diseases (NCDs) accounting for more than 50% of all deaths, as per WHO study. While NCDs such as cardiovascular diseases constitute of the larger share of India’s disease burden, other NCDs with a lower prevalence but significant impact on patient’s lives often remain neglected.
In May 2014, at the Sixty-seventh World Health Assembly, the World Health Organisation recognized psoriasis as a non-communicable disease. The Assembly went on to highlight psoriasis as a chronic, noncommunicable and disabling disease with no cure. Additionally, it was also highlighted that psoriasis comes with an elevated risk of co-morbidities, including cardiovascular diseases, diabetes, obesity, etc.
Unlike the common belief and perception, psoriasis is an autoimmune condition which is neither contagious nor merely a cosmetic skin condition.
What is the main cause of Psoriasis?
In psoriasis, the immune system mistakenly starts attacking healthy skin cells, accelerating the process of formation of skin cells and causing the dead skin cells to rapidly build up on the skin’s surface. This gives a raised, scaly, itchy, dry, and red appearance to the skin, commonly found on the elbows, knees and scalp. Excessive inflammation has been found to be a critical feature of psoriasis. Keep in mind that autoimmune diseases can be categorized as part of the larger group of non-communicable diseases. Research indicates that autoimmune diseases (ADs) can be considered the 10th most common cause of mortality in developing countries.
Psoriasis: Mental Health Burden
In 2010, the Global Burden of Disease Study showed the estimated burden of diseases across 187 countries, which included 15 skin disorders. Of 176 health conditions that were studied, Psoriasis received a high DALY score, given the various psychological and metabolic comorbidities associated with it.
Note that Disability-Adjusted Life Years or DALYs is a measure of overall disease burden and counted as the number of years lost due to ill-health, disability or early death. Therefore, one DALY can be considered the equivalent of one year’s loss of healthy life.
The fact that the Age-Standardized DALY Rate per 100 000 Persons for psoriasis was calculated at 66% higher than viral and fungal skin diseases, scabies and melanoma emphasizes the extensive health burden and higher associated DALYs of the condition.
The Mental Health Issue Brief published by the National Psoriasis Foundation (USA) indicates that psoriasis is independently associated with stress-related disorders, such as post-traumatic stress disorder (PTSD). In fact, of the 777 million Years Lived with Disability (YLDs) from all causes in 2010, some of the main contributors to global YLDs were mental and behavioral disorders.
The WHO study on Depression and Other Common Mental Disorders shows 4.5% of India’s population is suffering from mental health disorders, including 2,443 DALYs per 100,000 people and an estimated national economic loss of $1.03 trillion.
Major NCDs linked to psoriasis
The World Health Organisation also recognizes and understands that psoriasis has an increased risk of certain comorbid conditions such as:
– cardiovascular diseases
– stroke and
– liver disease
India’s risk of NCDs is already on the rise – NCDs which would typically be present in people of 55 years of age and above in many developed countries are now witnessing their onset in India almost a decade earlier, at about 45 years of age. These include cardiovascular diseases (CVDs), with 28.1 percent of all deaths in India caused by heart conditions.
Note that CVDs are one of the leading co-morbidities of psoriasis. Studies also indicate that psoriasis is associated with CVD risk factors, such as obesity and hypertension. When CVDs are associated with psoriasis, blood vessels can become inflamed and can lead to atherosclerosis – a chronic systemic inflammatory disease which is the build-up of plaque inside artery walls. Plaque slows or interrupts the flow of blood to the heart which heightens the risk of heart disease and heart attack.
With the existing burden of psoriasis and additional implications of co-morbidities such as CVDs, research shows that 75% of patients believed that psoriasis had moderate to large negative impact on their quality of life (QoL), which affects their daily activities.
The prevalence of psoriasis stands somewhere between 2 to 3 percent of the total population worldwide which poses an increased need for awareness on the condition.
Psoriasis – Misconceptions in India
Despite its extensive physical and mental health burden, including the risk of major NCDs, psoriasis remains underestimated in India. These are some reasons why most patient cases are being underreported and data is also limited or even excluded from larger studies:
– Low awareness of psoriasis and subsequent delayed or incorrect diagnosis can also result in significant negative impact on patients’ health related quality of life (HRQoL)
– Misconceptions surrounding the disease have resulted in its low awareness
– According to a global survey, 66% of all psoriasis patients in India experienced discrimination or humiliation due to their skin
– Of these, 36% patients admitted to feeling ashamed of their skin and the way they look and 24% have been stared at in public
Despite its significant impact on patient’s lives, psoriasis continues to be pushed aside as a skin disease which is contagious in nature. With new and advanced treatment options such as biologic therapies, patients suffering from moderate to severe psoriasis are able to achieve remission for longer periods of time. It is, however, important as a first step for medical experts, families and communities to work together to raise more awareness and break the stigma around psoriasis. Greater collective visibility on NCDs such as psoriasis will play a vital role in reducing the overall disease burden in the country.
(The columnist is Director, RSV Skin Clinic and Senior Consultant, Apollo Hospitals, Chennai. Views expressed are the author’s own.)