Cause-specific mortality in patients with severe psoriasis: a population-based cohort study in the U.K

Topic: Risk, prevention and care in population studies

Background Severe psoriasis is associated with excess mortality and increased risk of cardiovascular death. Population-based data evaluating cause-specific mortality in patients with psoriasis are limited. Objectives To describe cause-specific mortality in patients with severe psoriasis. Methods We performed a cohort study from 1987 to 2002 of patients ≥18 years using the General Practice Research Database. We compared patients with a psoriasis code and a history of systemic therapy consistent with severe psoriasis (n=3603) with patients with no history of psoriasis (n=14,330). Age- and sex-adjusted Cox models were created for each of the leading causes of death defined by the Centers for Disease Control. Results Patients with severe psoriasis were at increased risk of death from cardiovascular disease [hazard ratio (HR) 1·57, 95% confidence interval (CI) 1·26-1·96], malignancies (HR 1·41, 95% CI 1·07-1·86), chronic lower respiratory disease (HR 2·08, 95% CI 1·24-3·48), diabetes (HR 2·86, 95% CI 1·08-7·59), dementia (HR 3·64, 95% CI 1·36-9·72), infection (HR 1·65, 95% CI 1·26-2·18), kidney disease (HR 4·37, 95% CI 2·24-8·53) and unknown/missing causes (HR 1·43, 95% CI 1·09-1·89). The absolute and excess risk of death was highest for cardiovascular disease (61·9 and 3·5 deaths per 1000 patient-years, respectively). Conclusions Severe psoriasis is associated with an increased risk of death from a variety of causes, with cardiovascular death being the most common aetiology. These patients were also at increased risk of death from causes not previously reported, such as infection, kidney disease and dementia. Additional studies are necessary to determine the degree to which excess causes of death are due to psoriasis, its treatments, associated behaviours, or other factors.

Key findings

• Background Severe psoriasis is associated with excess mortality and increased risk of cardiovascular death.
• Results Patients with severe psoriasis were at increased risk of death from cardiovascular disease [hazard ratio (HR) 1·57, 95% confidence interval (CI) 1·26-1·96], malignancies (HR 1·41, 95% CI 1·07-1·86), chronic lower respiratory disease (HR 2·08, 95% CI 1·24-3·48), diabetes (HR 2·86, 95% CI 1·08-7·59), dementia (HR 3·64, 95% CI 1·36-9·72), infection (HR 1·65, 95% CI 1·26-2·18), kidney disease (HR 4·37, 95% CI 2·24-8·53) and unknown/missing causes (HR 1·43, 95% CI 1·09-1·89).
• Conclusions Severe psoriasis is associated with an increased risk of death from a variety of causes, with cardiovascular death being the most common aetiology.
• These patients were also at increased risk of death from causes not previously reported, such as infection, kidney disease and dementia.

Why it matters

In this cohort, patients with severe psoriasis were at increased risk of death from dementia (hazard ratio 3.64) among other causes. The study describes an association between severe psoriasis and cause-specific mortality, not a treatment or prevention for Alzheimer's disease.

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Study details

• Study designcohort study
• Participants3,603
• Evidence strengthModerate

Read the original

• DOI: 10.1111/j.1365-2133.2010.09941.x
• PubMed: 20633008
• Original source →
• Free full text: PubMed Central →

Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).

@article{abuabara2010-20633008,
  author  = {Abuabara, K. and Azfar, R. S. and Shin, D. B. and Neimann, A. L. and Troxel, A. B. and Gelfand, J. M.},
  title   = {{Cause-specific mortality in patients with severe psoriasis: a population-based cohort study in the U.K}},
  journal = {The British journal of dermatology},
  year    = {2010},
  doi     = {10.1111/j.1365-2133.2010.09941.x},
  pmid    = {20633008},
  url     = {https://doi.org/10.1111/j.1365-2133.2010.09941.x}
}

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