Patients With Psoriasis Have 2-Fold Higher Risk for Mortality

The study adds to the current literature by demonstrating the increased and independent risk for mortality-associated psoriasis, using a nationally representative sample of the US population.

In the United States, patients with psoriasis have a 2-fold higher risk for mortality compared with individuals without psoriasis, a study in the Journal of the American Academy of Dermatology suggests. The risk for mortality in these patients appears to be partially mediated by the higher prevalence of infectious, cardiovascular, and neoplastic disorders that are frequently observed in patients with psoriasis.

The ongoing, cross-sectional National Health and Nutrition Examination Survey (NHANES) was used to identify patients aged >10 years with self-reported psoriasis (n=347) and control patients without psoriasis (n=12,684). Only individuals who participated in the NHANES between 2003 and 2006, as well as 2009 and 2010, were included in the retrospective study.

Medical history questionnaires were used to assess participants’ comorbidities, including history of cancer, cardiovascular disease, chronic kidney disease, and diabetes mellitus. Data linked from national databases were examined to identify associated mortality rates.

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The presence of psoriasis was associated with a 1.99-fold higher risk for mortality during a 52.3-month follow-up period compared with nonpsoriatic control patients (hazard ratio, 1.99; 95% CI, 1.01-3.93; P =.047), according to the adjusted analysis. Female sex and income were associated with a lower mortality risk, whereas smoking and increasing age drove the higher risk for mortality. Comorbidities that partially mediated the increased risk for mortality in patients with psoriasis included cardiovascular disease (15.5%), chronic obstructive pulmonary disease (8.7%), cancer (11.7%), diabetes mellitus (5.9%), chronic kidney disease (4.2%), and stroke (4.7%).

Limitations of the analysis include its retrospective nature, as well as the self-reported nature of some of the data.

“Considering the different guidelines and use of systemic therapies between countries,” the researchers wrote, “future population-based studies investigating the effect of systemic therapies on mortality risk are essential for understanding the long-term effects of these medications.”

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Semenov YR, Herbosa CM, Rogers AT, et al. Psoriasis and mortality in the US: Data from the National Health and Nutrition Examination Survey [published online August 12, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.08.011