Jagou M, Bastuji-Garin S, Bourdon-Lanoy E, Penso-Assathiany D, Roujeau J-C
Department of Dermatology, University of Paris 12, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France.
Br J Dermatol. 2006 Nov;155(5):1006-12. doi: 10.1111/j.1365-2133.2006.07402.x.
Few epidemiological studies assessing the prevalence of chronic dermatosis are available in France and most of these studies have used biased samples drawn from specific subpopulations. As several recent studies have mentioned that self-reported diagnosis either underestimates or overestimates disease prevalence, the validity of such data is questionable.
To evaluate the agreement between self-reported and dermatologists' diagnoses for five chronic dermatoses: acne, eczema, fungal infection, psoriasis and seborrhoeic dermatitis, and to analyse the factors associated with patients' diagnosis knowledge.
PATIENTS/METHODS: A cross-sectional study was conducted on the national day of skin tumour screening in April 2003. A self-administered questionnaire was completed by patients and a standard form was completed by dermatologists after clinical examination. A total of 4,622 adults were examined by a dermatologist in 134 screening centres across France. The agreement between self-reported and dermatologists' diagnoses was analysed using the kappa index. Characteristics of patients who were aware of their diagnosis were compared with those of patients who were not, by using multivariate logistic regression models.
The demographic characteristics of the sample differed from those of the French population. The self-reported prevalence was significantly lower than the actual prevalence for all diseases except eczema. Underestimations ranging from 23% to 35% were observed in nearly all subgroups of our population. The agreement between self-reported and dermatologists' diagnoses was low to moderate. Many cases of chronic skin diseases were diagnosed in patients who did not report them. Diagnosis knowledge was poorer in those above 54 years of age and better for patients treated for the condition and those with impairment of social life.
We observed a low agreement between self-reported and dermatologists' diagnoses for five chronic diseases. Self-reports underestimated the actual prevalence of four of five common diseases.
法国很少有流行病学研究评估慢性皮肤病的患病率，且大多数此类研究使用的是从特定亚人群中抽取的有偏差样本。由于最近的几项研究提到，自我报告的诊断要么低估要么高估了疾病患病率，此类数据的有效性值得怀疑。
评估自我报告诊断与皮肤科医生对痤疮、湿疹、真菌感染、银屑病和脂溢性皮炎这五种慢性皮肤病诊断之间的一致性，并分析与患者诊断知识相关的因素。
患者/方法：在2003年4月全国皮肤肿瘤筛查日进行了一项横断面研究。患者完成一份自填式问卷，皮肤科医生在临床检查后填写一份标准表格。法国134个筛查中心共有4622名成年人接受了皮肤科医生的检查。使用kappa指数分析自我报告诊断与皮肤科医生诊断之间的一致性。通过多变量逻辑回归模型，将知晓自己诊断结果的患者特征与不知晓的患者特征进行比较。
样本的人口统计学特征与法国人口不同。除湿疹外，所有疾病的自我报告患病率均显著低于实际患病率。在我们研究人群的几乎所有亚组中，低估率在23%至35%之间。自我报告诊断与皮肤科医生诊断之间的一致性为低到中等。许多慢性皮肤病患者未报告自己患病却被诊断出。54岁以上人群的诊断知识较差，接受过该病治疗的患者以及社交生活受影响的患者诊断知识较好。
我们观察到自我报告诊断与皮肤科医生对五种慢性病诊断之间的一致性较低。自我报告低估了五种常见疾病中四种疾病的实际患病率。
