Alcohol-Associated Mortality in People With Psoriasis: Examining the Mortality Gap

Persons with psoriasis have an approximately 60% increased risk for alcohol-related death compared with age-matched and gender-matched peers from the general population, according to the results of a study published in JAMA Dermatology.

An incident cohort of patients 18 years or older with psoriasis was identified from 1998 through 2014 using the Clinical Practice Research Datalink. Data from this cohort were then linked with mortality records from the national Hospital Episode Statistics and the Office for National Statistics. Patients with psoriasis were matched with up to 20 comparison participants without psoriasis with respect to age, gender, and general practice.

Alcohol-related deaths were established using the Office for National Statistics mortality records. The cause-specific hazard ratio (HR) for alcohol-related mortality was assessed through use of a Cox proportional hazard model, with adjustments for socioeconomic status.

The cohort included 55,537 individuals with psoriasis and 854,314 persons without psoriasis. Median age at index date was 47 years (interquartile range [IQR]: 27), and 44.9% of the total cohort were men. During a median follow-up of 4.4 years (IQR: 6.2), the alcohol-related mortality rate was 4.8 per 10,000 person-years (n=152; 95% CI, 4.1-5.6) in the psoriasis arm vs 2.5 per 10,000 person-years (n=1118; 95% CI, 2.4-2.7) in the comparison arm. The adjusted HR for alcohol-related mortality in patients with psoriasis was 1.58 (95% CI, 1.31-1.91). Predominant causes of alcohol-related deaths included alcoholic liver disease (65.1%), fibrosis and cirrhosis of the liver (23.7%), and mental and behavioral disorders associated with alcohol use (7.9%).

The researchers concluded that individuals who are diagnosed with psoriasis have an increased likelihood for premature mortality caused by alcohol consumption and other alcohol-related causes. “These findings [show the importance of] routine screening, identification, and treatment, using the Alcohol Use Disorders Identification Test in both primary and secondary care to detect alcohol consumption and misuse among people diagnosed with psoriasis,” the investigators concluded.

Reference

Parisi R, Webb RT, Carr MJ, et al. Alcohol-related mortality in patients with psoriasis: a population-based cohort study [published online September 15, 2017]. JAMA Dermatol. doi:10.1001/jamadermatol.2017.3225