US Veterans Have Higher Prevalence of Skin Cancer, Psoriasis Versus Non-Veterans

Shawheen J. Rezaei, MPhil

Credit: Stanford University

US veterans maintain higher prevalence and odds of different dermatologic conditions compared to non-veterans, new findings suggest, with the primary examples being skin cancer and psoriasis.¹

These data were the conclusion of new research led by Shawheen J. Rezaei, MPhil, from the department of dermatology at Stanford University’s School of Medicine. Resaei and colleagues sought to compare veterans and nonveterans’ prevalence and odds of eczema, psoriasis, and other conditions.

They highlighted the importance of skin health among veterans, citing the fact that melanoma in veterans had been shown to be diagnosed during later stages. The team also noted that poorer rates of survival had been seen among veterans versus rates of a comparison cohort within a national sample.²

“To address (the information) gap, our study uses the National Health and Nutrition Examination Survey (NHANES) across 2 decades…to investigate the prevalence and likelihood of various dermatologic conditions (skin cancer, psoriasis, and eczema/dermatitis/inflamed rash) and skin cancer risk factors data available in NHANES among veterans compared with nonveterans,” Rezaei et al. wrote.¹

Background and Trial Design

The investigators implemented a set of nationally representative data which was drawn from the aforementioned National Health and Nutrition Examination Survey (NHANES) over the course of 20 years, specifically 1999 - 2018. The research team’s gathering of data involved a multistage sampling approach, with the team ensuring that the stratification and sample weights led to national representation.

NHANES itself is conducted by officials at the Centers for Disease Control and Prevention (CDC) on an every-2-years basis. NHANES implements surveys of the general population within the US, with exclusions being active military personnel as well as institutionalized individuals.

All of the investigators’ data gathered for the survey was given ethical approval from the National Center for Health Statistics Institutional Review Board. Additionally, review was waived by the Stanford Institutional Review Board for this study, given the fact that the NHANES information had been de-identified and accessible to the greater public.

The research team performed their statistical analyses through the use of Stata version 17.0. They set significance levels set at P < .01, P < .05, and P < .10 (two-sided).

Major Conclusions

Overall, there were a total of 61,307 participants included in this research, with 54,554 nonveterans as well as 6,753 veterans. The research team concluded that veterans had higher rates of prevalence than the non-veteran cohort in terms of melanoma history (2.2% compared to 0.6%; P < .001) as well as history of skin cancer (9.0% compared to 2.9%; P < .001).

Once the team adjusted their findings for factors related to demographics, they reported that veterans were shown to have increased odds of having any form of skin cancer (OR, 1.72; 95% CI, 1.23-2.40). This was true specifically of melanoma (OR, 2.27; 95% CI, 1.17-4.39) versus the odds among the non-veteran cohort.

Furthermore, the investigators noted an increase in prevalence of psoriasis among the veteran cohort (4.5% compared to 2.9% in nonveterans; P = .002). They added that the likelihood of a psoriasis diagnosis was 61% greater among those who had been veterans versus those who were not (OR, 1.61; 95% CI, 1.05-2.46).

“Public health measures seeking to address veteran health care differences could emphasize primary preventive strategies to mitigate risk and early detection of dermatologic conditions through regular skin examinations,” they wrote.

References

1. ^{Rezaei SJ, Kim J, Onyeka S, et al. Skin Cancer and Other Dermatologic Conditions Among US Veterans. JAMA Dermatol. Published online September 04, 2024. doi:10.1001/jamadermatol.2024.3043.}
2. ^{Chang MS, La J, Trepanowski N, et al. Increased relative proportions of advanced melanoma among veterans: a comparative analysis with the Surveillance, Epidemiology, and End Results registry. J Am Acad Dermatol. 2022;87(1):72-79. doi:10.1016/j.jaad.2022.02.063.}