Prevalence of Acne in Chinese College Students and Its Associations with Social Determinants and Quality of Life
Acne vulgaris, a chronic inflammatory skin condition, ranks as the eighth most prevalent disease globally. Among adolescents, over 85% experience acne at some point, with significant physical and psychological impacts. College students, in particular, face heightened stress due to acne’s recurrent nature and potential for scarring or post-inflammatory hyperpigmentation. While numerous studies in China have explored acne in adolescents, most are hospital-based, introducing selection bias by overrepresenting severe cases. To address this gap, a population-based cross-sectional study was conducted to estimate the prevalence of moderate-to-severe acne among Chinese college students and evaluate its associations with social determinants and quality of life (QoL).
Study Design and Methodology
The study, approved by ethics committees at Huazhong University of Science and Technology and Xiangya Hospital, Central South University, employed a cluster sampling framework. Five universities across diverse geographical regions—Changsha, Wuhan, Xiamen, Urumqi, and Hohhot—were selected. First-year college students participated in a health examination and online questionnaire during September–October 2018. A total of 20,138 students (74.3% of 27,114 eligible registrants) completed the survey, forming the final cohort.
Trained dermatologists diagnosed acne severity using the Pillsbury Grading System: Grade 1 (mild), Grades 2–3 (moderate), and Grade 4 (severe). Moderate-to-severe acne served as the primary outcome. Social determinants, including geographic region, gender, ethnicity, annual household income, and body mass index (BMI), were assessed. Mental well-being and QoL were evaluated using validated tools: the Generalized Anxiety Disorder-2 (GAD-2), Patient Health Questionnaire-2 (PHQ-2), and European Quality of Life-5 Dimensions (EQ-5D). Health utility scores were derived from EQ-5D responses using preference-based weights.
Statistical analyses utilized two-level multivariable logistic models (students nested within cities) to assess associations between acne and demographic factors. Linear models adjusted for covariates examined links between acne and mental health/QoL outcomes. All analyses were performed using SAS 9.4, with significance set at p < 0.05.
Key Findings
Prevalence and Demographic Correlates
The overall prevalence of moderate-to-severe acne was 10.4% (2,087/20,138). Significant geographic variation emerged: students from northern China exhibited the highest prevalence (12.8%), followed by northeastern (12.5%), central (10.6%), southern (10.2%), southwestern (9.8%), eastern (9.3%), and northwestern regions (9.1%) (χ² = 39.645, p < 0.001).
Gender disparities were striking: males had a 13.4% prevalence compared to 7.2% in females (χ² = 203.861, p < 0.001). Multivariable analysis confirmed female gender as protective (aOR: 0.47; 95% CI: 0.42–0.52; p < 0.001). Students in northern China faced elevated odds of acne relative to other regions (aORs ranged from 0.61 [east] to 0.66 [northwest]; all p < 0.05).
BMI differed significantly between acne groups (21.56 ± 3.67 kg/m² for moderate/severe vs. 21.23 ± 3.53 kg/m² for mild/clear; t = -4.963, p < 0.001). However, BMI lost significance in adjusted models (aOR: 1.01; 95% CI: 0.99–1.02; p = 0.112). Ethnicity (Han vs. non-Han) and household income showed no significant associations.
Mental Well-Being and Quality of Life
Contrary to expectations, moderate-to-severe acne did not significantly impair mental health or QoL. Median GAD-2 and PHQ-2 scores were identical across groups (GAD-2: 0 [IQR 0–2]; PHQ-2: 0 [IQR 0–2]). In adjusted linear models, acne was unrelated to anxiety (b = -0.015, SE = 0.028; p = 0.604), depression (b = -0.012, SE = 0.029; p = 0.670), or health utility (b = 0.002, SE = 0.002; p = 0.141).
EQ-5D responses revealed marginal differences: the moderate/severe group reported slightly less pain/discomfort (5.2% vs. 6.4%; χ² = 4.397, p = 0.036) and a minimally higher health utility score (0.97 ± 0.06 vs. 0.97 ± 0.07; t = -2.011, p = 0.044). These differences lacked clinical significance, suggesting limited QoL impact.
Discussion
Geographic and Gender Disparities
The north-south gradient in acne prevalence aligns with regional climatic and dietary patterns. Northern China’s dry climate, air pollution, and high-glycemic diets (e.g., wheat-based noodles) may exacerbate sebum production and inflammation. Conversely, humid southern regions with rice-dominated diets might offer protective effects.
The male predominance in acne aligns with hormonal profiles (e.g., higher androgens) and lifestyle factors (e.g., inadequate skincare). Females’ lower prevalence may reflect earlier healthcare-seeking behavior, leading to milder cases in population studies.
BMI and Acne: A Nuanced Relationship
While higher BMI correlated with acne severity in unadjusted analyses, this association vanished after controlling for confounders. This contrasts with studies linking obesity to insulin resistance and heightened IGF-1, which stimulates sebum production. The null finding here may reflect the cohort’s relatively narrow BMI range (mean ~21 kg/m²), limiting variability.
Mental Health and QoL Paradox
The absence of significant mental health impacts contrasts sharply with hospital-based studies. This discrepancy likely stems from selection bias: population-based cohorts include milder cases, whereas clinical samples overrepresent severe, distressing presentations. Additionally, the EQ-5D’s generic design may lack sensitivity to dermatology-specific QoL impairments, as evidenced by ceiling effects (mean utility ≥ 0.97).
Strengths and Limitations
As China’s largest population-based acne study, this work provides robust prevalence estimates free from healthcare access biases. However, the cross-sectional design precludes causal inferences. Generalizability to non-college populations remains uncertain.
Conclusion
Moderate-to-severe acne affects 1 in 10 Chinese college students, with marked geographic and gender disparities. While males and northern residents face elevated risks, acne’s impact on mental health and QoL appears minimal in this population-based context. Future research should employ longitudinal designs and dermatology-specific QoL instruments to capture acne’s psychosocial burden more accurately.
doi.org/10.1097/CM9.0000000000001292
Was this helpful?
0 / 0