Psoriasis, Especially Severe Disease, Associated With Increased Risk for All-Cause Mortality

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Although associations were consistent, a key limitation of this meta-analysis was that included studies were heterogeneous in several aspects.
Although associations were consistent, a key limitation of this meta-analysis was that included studies were heterogeneous in several aspects.

Psoriasis is associated with elevated rates of all-cause mortality in a dose-response manner with disease severity, as well as with cause-specific mortality, according to the results published in the Journal of the American Academy of Dermatology.

With the recognition that an overview of the mortality risk associated with psoriasis is lacking, investigators conducted a meta-analysis and systematic review of risk for mortality among individuals with psoriasis. Included in the review were studies that reported all-cause or cause-specific mortality risk estimates in persons with psoriasis compared with the general population or with individuals free of psoriasis. A total of 12 studies were included in the analysis.

Among 6 studies of 299,374 patients with psoriasis, the pooled risk ratio (RR) for all-cause mortality was 1.21 (95% CI, 1.14-1.28; P <.001). Among 4 studies of 265,292 individuals with mild psoriasis, the pooled RR for all-cause mortality was 1.13 (95% CI, 1.09-1.16; P =.048). Among 6 studies of 36,428 patients with severe psoriasis, the pooled RR for all-cause mortality was 1.52 (95% CI, 1.35-1.72; P <.001).

Among 5 studies of 285,675 patients with psoriasis, the pooled RR for cardiovascular (CV) mortality was 1.15 (95% CI, 1.09-1.21; P =.02). Among 3 studies of 188,223 individuals with mild psoriasis, the pooled RR for CV mortality was 1.05 (95% CI, 0.92-1.20; P <.001). Among 4 studies of 17,317 patients with severe psoriasis, the pooled RR for CV mortality was 1.38 (95% CI, 1.09-1.74; P <.001).

With respect to non-CV causes of death, the risk for mortality from kidney and liver disease was highest. The RRs for mortality from kidney disease was 2.16 (95% CI, 1.37-3.40) among all patients with psoriasis, 2.20 (95% CI, 1.36-3.56) among individuals with mild psoriasis, and 3.54 (95% CI, 1.73-7.26) among those with severe psoriasis. In addition, the RRs for mortality from liver disease were 2.00 (95% CI, 1.34-2.99) among all patients with psoriasis, 4.26 (95% CI, 1.87-9.73) among individuals with mild psoriasis, and 3.97 (95% CI, 2.87-5.50) among those with severe psoriasis.

Moreover, the RRs for mortality from infections was 1.24 (95% CI, 1.14-1.31) among all patients with psoriasis, 1.41 (95% CI, 1.11-1.79) among individuals with mild psoriasis, and 1.58 (95% CI, 1.22-2.05) among those with severe psoriasis. Significantly increased mortality risk from neoplasms was also reported among patients with severe psoriasis, as well as from chronic lower respiratory disease in all individuals with psoriasis and in those with mild psoriasis.

The investigators concluded that on the basis of the findings from this study, patients with psoriasis, and in particular those with risk factors and severe disease, should receive appropriate screening and preventive interventions. Additional research is warranted to evaluate the effect of psoriasis on mortality independent of mortality risk factors, to elucidate cause-specific mortality among patients with psoriasis, and to establish the mechanisms that induce excess mortality.

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Reference

Dhana A, Yen H, Yen H, Cho E. All-cause and cause-specific mortality in psoriasis: a systematic review and meta-analysis [published online December 24, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.12.037

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