Patients with psoriasis have an increasing Charlson Comorbidity Index (CCI) score over time, according to study data published in the Journal of the European Academy of Dermatology and Venereology.
Investigators analyzed longitudinal trends of psoriasis hospitalizations during the past 20 years in the United States (US) after biologic agents were introduced. Data were obtained from the National Inpatient Sample (NIS) database, a representative stratified sample of 20% of all US hospitalizations. The study authors conducted a 21-year longitudinal trend analysis from 1998 to 2018 and sampled every 5th year of data to analyze hospitalization trends over time.
The researchers also searched for hospitalizations for patients aged 18 years or younger who had a “principal” or “secondary” diagnosis of psoriasis according to ICD codes in the corresponding year and performed a subgroup analysis for patients with psoriatic arthritis. Multivariable logistic and linear regression analysis were used for calculating adjusted P trend for categorical and continuous outcomes, respectively. The investigators also adjusted for changes in demographics, including age, sex, race, insurance, and income, as well as CCI score over time.
The incidence of hospitalizations with a principal or secondary diagnosis of psoriasis increased from 17.9 in 1998 to 52 per 100,000 persons in 2018 (adjusted P trend <.0001). The percentage of all patients with psoriasis hospitalized with psoriasis as their principal diagnosis decreased from 4.1% in 1998 to 1% in 2018 (adjusted P trend <.0001).
The percentage of patients with psoriasis and a CCI of 3 or higher increased from 13.9% in 1998 to 30.9% in 2018 (adjusted P trend <.0001). In addition, inpatient mortality and mean hospital length of stay decreased, and hospital charges for hospitalized patients with psoriasis increased (adjusted P trend <.0001).
The trends were comparable in the patients with psoriatic arthritis for all outcomes except for mortality, for which there was no statistically significant trend.
The study authors hypothesized that use of biologic agents for moderate to severe psoriasis and psoriatic arthritis has reduced the need for hospital admission because of psoriasis flare and may have contributed to the decline in mortality of patients with psoriasis over time.
“The increasing CCI of psoriasis patients warrants need for increased outpatient screening and management of medical comorbidities to reduce preventable hospitalizations,” stated the researchers.
Edigin E, Rivera Pavon MM, Eseaton PO, Manadan A. National trends of psoriasis hospitalizations: a 2-decade longitudinal United States population based study. J Eur Acad Dermatol Venereol. Published online August 9, 2021. doi:10.1111/jdv.17590