U.S. veterans may have a significantly higher risk of skin cancer history and other dermatologic conditions compared with nonveterans, according to a cross-sectional study.

In the study, published in JAMA Dermatology, investigators analyzed the data of 61,307 participants (54,554 nonveterans and 6,753 veterans) in the 1999 to 2018 National Health and Nutrition Examination Survey (NHANES).

Demographic analysis revealed that veterans were predominantly male (92.74%) and older, with 50.87% aged 60 years or older, compared with 20.40% of nonveterans in the same age range. The veteran population had a higher percentage of non-Hispanic White individuals (80.42% vs 65.78%), higher education levels (96.94% with ≥ 9th grade education vs 93.76%), and higher income (88.42% with annual household income ≥ $20,000 vs 83.42%).

The investigators employed a multistage sampling design with sample weights for national representativeness. They merged three questionnaires: demographics, medical conditions, and dermatology.

Logistic regressions assessed the likelihood of dermatologic disease history, controlling for demographic covariates. Stata version 17.0 was used for analysis, with statistical significance determined at P < .01, P < .05, and P < .10 (two-sided). The study adhered to STROBE reporting guidelines for cross-sectional studies.

Sample sizes for specific analyses varied:

• Skin cancer history: 48,278 nonveterans and 6,713 veterans
• Psoriasis: 23,142 nonveterans and 2,361 veterans
• Eczema/dermatitis/inflamed rash: 11,080 nonveterans and 1,299 veterans
• Sun reactivity: 32,207 nonveterans and 2,559 veterans
• Outdoors during work day: 15,704 nonveterans and 896 veterans.

The investigators found that veterans had a 72% higher risk of any skin cancer history (odds ratio [OR] = 1.72, 95% confidence interval [CI] = 1.23–2.40) and more than twice the risk of melanoma history (OR = 2.27, 95% CI = 1.17–4.39) compared with nonveterans, after adjusting for demographic factors.

The prevalence of self-reported skin cancer history was higher for veterans across all subtypes:

• Any skin cancer: 9.0% veterans vs 2.9% nonveterans (P < .001)
• Melanoma: 2.2% veterans vs 0.6% nonveterans (P < .001)
• Nonmelanoma skin cancer: 5.1% veterans vs 1.6% nonveterans (P < .001)
• Skin cancer of unknown subtype: 2.2% veterans vs 0.8% nonveterans (P < .001).

The investigators also discovered a higher prevalence and risk of other dermatologic conditions among veterans:

• Psoriasis: Veterans had a 61% higher risk of a psoriasis diagnosis (OR = 1.61, 95% CI = 1.05–2.46). Prevalence was 4.5% in veterans vs 2.9% in nonveterans (P = .002).
• Eczema/dermatitis/inflamed rash: Veterans had an increased risk when localized to the arms (OR = 1.40, 95% CI = 1.00–1.96, P < .10) or torso (OR = 1.40, 95% CI = 0.95–2.07, P < .10).

Sun reactivity and behavior data showed:

• Veterans had a 44% to 45% increased risk of severe sunburn after half an hour in sun exposure, even after adjusting for demographic factors.
• Veteran status was positively associated with being outdoors on a work day (OR = 1.22, 95% CI = 1.04–2.25).
• Outdoor exposure during work day (9 AM to 5 PM): no outdoor exposure = 22.33% veterans vs 31.50% nonveterans, ≤ 4 hours outdoor exposure = 59.03% veterans vs 56.20% nonveterans, and 4 hours outdoor exposure = 18.64% veterans vs 12.29% nonveterans.

The investigators noted limitations, including the self-reported nature of the data and potential sampling bias caused by the predominance of older White males in the veteran population. The study's findings highlighted the increased prevalence of skin cancer and other dermatologic conditions among U.S. veterans compared with nonveterans.

The authors declared having no competing interests.