Actinic Skin Damage and Mortality - the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study

Abstract

BackgroundExposure to sunlight may decrease the risk of several diseases through the synthesis of vitamin D, whereas solar radiation is the main cause of some skin and eye diseases. However, to the best of our knowledge, the association of sun-induced skin damage with mortality remains unknown.Methodology/Principal FindingsSubjects were 8472 white participants aged 25–74 years in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Cardiovascular disease mortality, cancer mortality, and all-cause mortality were obtained by either a death certificate or a proxy interview, or both. Actinic skin damage was examined and recorded by the presence and severity (absent, minimal, moderate, or severe) of overall actinic skin damage and its components (i.e., fine telangiectasia, solar elastosis, and actinic keratoses). Cox regression and Kaplan-Meier methods were applied to explore the associations. A total of 672 cancer deaths, 1500 cardiovascular disease deaths, and 2969 deaths from all causes were documented through the follow-up between 1971 and 1992. After controlling for potential confounding variables, severe overall actinic skin damage was associated with a 45% higher risk for all-cause mortality (95% CI: 1.22, 1.72; P<0.001), moderate overall skin damage with a 20% higher risk (95% CI: 1.08., 1.32; P<0.001), and minimal overall skin damage with no significant mortality difference, when compared to those with no skin damage. Similar results were obtained for all-cause mortality with fine telangiectasia, solar elastosis, and actinic keratoses. The results were similar for cancer and cardiovascular disease mortality.ConclusionsThe present study gives an indication of an association of actinic skin damage with cardiovascular disease, cancer and all-cause mortality in white subjects. Given the lack of support in the scientific literature and potential unmeasured confounding factors, this finding should be interpreted with caution. More independent studies are needed before any practical recommendations can be made.

Prevalence of Actinic Keratosis and Its Risk Factors in the General Population: The Rotterdam Study

“…These differences in prevalences could be due to the geographic variability in UV radiation levels (Australia 4United States of America 4Europe) and the differences between the studied populations (e.g., high-risk patients, pigmentation status and age restrictions). Moreover, skin examinations and AK count were not conducted uniformly in these studies (Green et al, 1988;Harvey et al, 1996a, b;He et al, 2011;Marks et al, 1986;Naldi et al, 2006).…”

“…Population-based studies investigating AK prevalence and its associated risk factors (Green et al, 1988;Harvey et al, 1996a;He et al, 2011;Marks et al, 1986;Naldi et al, 2006) conclude that elderly subjects with European ancestry and high cumulative UV exposure have the highest risk of developing AKs. However, these studies are few and report prevalences of AK varying from 1.4 to 59.2%.…”

Atopic dermatitis is not associated with actinic keratosis: cross‐sectional results from the Rotterdam study

“…Squamous cell carcinoma (SCC) occurs at a comparable rate with melanoma, especially in elderly individuals and those chronically exposed to the sun . Actinic keratosis (AK) is a keratinocyte premalignancy and is also highly prevalent (25% of Dutch inhabitants aged > 50 years) and is associated with high levels of cumulative UV exposure …”

Nonmelanoma skin cancer and risk of all-cause and cancer-related mortality: a systematic review

“…Exclusion criteria included: a) only reported associations with cause-specific fatal outcomes other than cancer such as suicide [22]; b) evaluation of NMSC-specific mortality; and c) assessment of rare skin cancers other than BCC or SCC, such as Merkel cell carcinoma and adnexal cell carcinoma, or precursor skin conditions, such as actinic keratosis [11]. …”