Screening rates for cardiometabolic comorbidities are suboptimal in patients with psoriasis, hidradenitis suppurativa, and atopic dermatitis, suggests study data published in Archives of Dermatological Research. Compared with healthy control patients, patients with psoriasis, hidradenitis suppurativa, and atopic dermatitis were less likely to undergo blood pressure, cholesterol, and obesity screening during outpatient visits. The increased risk for cardiovascular comorbidity in patients with these disorders necessitates better screening rates.
Investigators extracted data from the National Ambulatory Medical Care Survey (NAMCS) from 2006 through 2015. The NAMCS is an annual, cross-sectional survey administered to nonfederally employed, office-based physicians around theUS. Participants are asked to provide data on approximately 30 patient visits during a randomly assigned 1-week reporting period. Participant selection is designed to provide a nationally representative estimate of ambulatory care utilization in the US. The present study extracted patient demographics, diagnoses, and cardiovascular assessments from visit summaries. Psoriasis, hidradenitis suppurativa, and atopic dermatitis were identified by International Classification of Disease 9th Edition diagnosis codes. Cardiovascular assessments included blood pressure or cholesterol measurements and metabolic screening using hemoglobin A1c (HgA1c), glucose, or body mass index (BMI). Multivariable logistic regression was performed to identify predictors of cardiovascular screening in patients. Estimates in patients with psoriasis, hidradenitis suppurativa, or atopic dermatitis were compared to estimates in patients without inflammatory skin disease. Weighted frequencies and proportions of visits were estimated for each screening test. Survey weights were incorporated in statistical analyses.
A weighted total of 9.61 (95% confidence interval [CI], 8.81-10.4) billion visits were observed between 2006 and 2015, including 143 (130-156) million visits with a diagnosis of psoriasis, hidradenitis suppurativa, or atopic dermatitis. The majority of visits were in adults (81.9% [81.2-82.6%]), women (58.5% [58.0-58.9%]), and non-Hispanic whites (67.6% [66.5-68.7%]). Blood pressure screening was performed significantly less frequently in patients with psoriasis (36.4% [31.0-42.2%]) and atopic dermatitis (41.9% [39.3-44.7%]) compared with all other patients (62.5% [95% CI, 61.5-63.6%]) (both P <.0001), the researchers noted. Per logistic regression analyses, patients with psoriasis were more likely to undergo cholesterol screening (odds ratio [OR], 1.82 [95% CI, 1.20-2.76]) than control patients. However, cholesterol screening was performed significantly less often in patients with hidradenitis suppurativa (OR, 0.03 [0.00-0.23]; P =.001) and atopic dermatitis (OR, 0.72; [0.55-0.94]; P =.02) than in the general population. HgA1c screening rates were lower in patients with atopic dermatitis (1.8% [1.3-2.5%]; P <.0001) and patients with psoriasis (1.9% [1.0-3.8%]; P =.01) than rates for all other visits. Rates for glucose screening were also low in atopic dermatitis (2.9% [2.1-3.8%]; P <.0001). Rates of obesity screening increased from the years 2006 through 2007 and 2014 through 2015 for atopic dermatitis (31.1% to 44.5%; P =.01), psoriasis (19.0% to 42.8%; P =.01), and hidradenitis suppurativa (28.6% to 74.2%; P =.001). Screening rates for blood pressure, cholesterol, and diabetes did not increase over time.
These data suggest that cardiometabolic screening rates remain low in patients with psoriasis, hidradenitis suppurativa, and atopic dermatitis, despite the increased risk for cardiovascular morbidity in these populations. As study limitations, investigators noted the lack of data on disease severity and the small cohort size for hidradenitis suppurativa. In addition, the NAMCS only collects data for a specific reporting period; cardiometabolic screening may have been performed for these same patients at a different time. Even so, these trends suggest that cardiovascular risks may be insufficiently addressed in patients with inflammatory skin diseases. “Efforts are needed to reduce knowledge and practice gaps and ultimately improve screening rates,” investigators wrote.
Singh P, Silverberg JI. Screening for cardiovascular comorbidity in United States outpatients with psoriasis, hidradenitis, and atopic dermatitis [published online May 11, 2020]. Arch Dermatol Res. doi: 10.1007/s00403-020-02087-w