More Severe Psoriasis Associated With Increased Risk of Death

Patients with psoriasis whose disease affects >10% of their body surface area (BSA) are at an increased risk for death compared with the general population, according to results from a  large population-based prospective study published in the Journal of Investigative Dermatology.

Data were collected prospectively from the date of the physician survey until the patient died, left the practice, or reached the end of the data collection period. Covariates included age, gender, body mass index (BMI), alcohol use, smoking, and medical comorbidities using the Charlson Comorbidity Index (CCI).

A total of 8760 adults with psoriasis and 87,600 individuals without psoriasis were included in the analysis. Higher rates of chronic kidney disease, chronic obstructive pulmonary disease, diabetes, and history of myocardial infarction were reported in patients in the psoriasis group. In the 8760 participants with psoriasis, 125 deaths were reported, resulting in a mortality rate of 3.36 deaths per 1000 person-years (95% CI, 2.81-3.99). In the 87,600 adults without psoriasis, 1188 deaths were reported, or 3.24 deaths per 1000 person-years (95% CI, 3.06-3.43).

Following stratification by physician-reported BSA, 58, 38, and 29 deaths were reported in the <3%, 3% to 10%, and >10% psoriasis groups, respectively. In age- and gender-adjusted models, only individuals with a >10% BSA had a significantly increased risk for death (hazard ratio [HR] 2.12; 95% CI, 1.46-3.07). When adjusting for CCI, the risk for mortality in patients with a BSA >10% remained elevated (HR 1.79; 95% CI, 1.23-2.59).

This study demonstrated that patients with psoriasis and a BSA >10% had a 1.79-fold increased risk for death compared with age- and sex-matched controls. Future research is warranted in order to better clarify the specific causes of mortality in patients with extensive psoriasis and determine the effects of various therapies on mortality risk.

Reference

Noe MH, Shin DB, Wan MT, Gelfand JM. Objective measures of psoriasis severity predict mortality: a prospective population-based cohort study [published online August 23. 2017]. J Invest Dermatol. doi:10.1016/j.jid.2017.07.841