Risk Factors Associated With Major Skin Diseases: A Cross-Sectional Study From Bangladesh

Skin diseases are prevalent in Bangladesh, affecting individuals across all age groups and significantly impacting both personal and community health.

This study aims to identify risk factors associated with certain skin diseases in Bangladesh, specifically examining lifestyle, environmental, food-related, and heritable factors.

A cross-sectional study was conducted across three major divisions in Bangladesh (Dhaka, Rangpur, and Chattogram) from December 2022 to July 2023. Data were collected from 788 respondents using a structured questionnaire through a purposive quota sampling technique. The questionnaire covered self-reported skin disease status, sociodemographic characteristics, and potential risk factors. The analysis employed univariate tools, principal component analysis (PCA) to reduce correlated risk factors into uncorrelated components, and principal component logistic regression (PCLR) to assess associations. Goodness-of-fit testing was conducted to validate model calibration, and sensitivity analyses adjusting for sociodemographic confounders were performed to confirm the robustness of identified associations.

Among the 788 respondents, 61.80% (n = 487) reported skin diseases. Among these, atopic dermatitis was the most prevalent condition (72.07%), followed by fungal infection (26.90%), acne vulgaris (20.74%), seborrheic dermatitis (13.55%), and psoriasis (8.21%); as multiple conditions could be reported concurrently, these percentages are not mutually exclusive. Through PCA and PCLR analyses, several associations were initially identified. Following rigorous goodness-of-fit testing, two associations demonstrated adequate model calibration: heritable factors were significantly associated with fungal infection, and environmental factors were significantly associated with acne vulgaris. A one-unit increase in heritable factors (for instance, having an additional family member with skin disease) increased the odds of fungal infection by 34% in unadjusted models (OR: 1.34, 95% CI: 1.08-1.66), and a one-unit increase in environmental factors increased the odds of acne vulgaris by 45% in unadjusted models (OR: 1.45, 95% CI: 1.16-1.80). After adjusting for age, sex, division, and disease-specific confounders, these associations remained significant (adjusted OR: 1.37, 95% CI: 1.09-1.74 for fungal infection; adjusted OR: 1.32, 95% CI: 1.05-1.67 for acne vulgaris), confirming their robustness.

This study provides valuable insights into risk factors associated with skin diseases in Bangladesh. The findings highlight that family history plays a significant role in fungal infection susceptibility, while environmental exposures are important determinants of acne vulgaris. The study underscores the importance of rigorous goodness-of-fit testing and confounder adjustment in observational research, as several initially significant associations did not demonstrate adequate model calibration or lost significance after adjustment. These validated findings suggest the need for targeted interventions addressing heritable predisposition for fungal infections and environmental mitigation strategies for acne vulgaris in Bangladesh.