The risk of mortality in patients with psoriasis: results from a population-based study.
OBJECTIVE
To determine the risk of mortality in patients with psoriasis.


METHODS
Cohort study.


METHODS
General practitioners participating in the General Practice Research Database in the United Kingdom, 1987-2002.


METHODS
Mild psoriasis, defined as any patient with a diagnostic code of psoriasis but no history of systemic therapy; severe psoriasis, any patient with a diagnostic code of psoriasis and a history of systemic therapy consistent with severe psoriasis. The unexposed (control) population was composed of patients with no history of a psoriasis diagnostic code. Control patients were selected in a 5:1 ratio from the same practice and date in practice as the patients with psoriasis.


METHODS
Hazard ratio (HR) of time to death using Cox proportional hazards models adjusted for age and sex.


RESULTS
There was no overall effect of mild psoriasis on mortality (HR, 1.0; 95% confidence interval [CI], 0.97-1.02), whereas patients with severe psoriasis demonstrated an increased overall mortality risk (HR, 1.5; 95% CI, 1.3-1.7). The association of severe psoriasis with mortality persisted after adjustment for risk factors for mortality (HR, 1.4; 95% CI, 1.3-1.6) and after exclusion of patients with inflammatory arthropathy (HR, 1.5; 95% CI, 1.3-1.8). Male and female patients with severe psoriasis died 3.5 (95% CI, 1.2-5.8) and 4.4 (95% CI, 2.2-6.6) years younger, respectively, than patients without psoriasis (P < .001).


CONCLUSIONS
Severe but not mild psoriasis is associated with an increased risk of death.
Gelfand
Joel M
JM
MSCE, Department of Dermatology, University of Pennsylvania School of Medicine, 2 Maloney Bldg, 3600 Spruce St, Philadelphia, PA 19104, USA. Joel.Gelfand@uphs.upenn.edu
Troxel
Andrea B
AB
Lewis
James D
JD
Kurd
Shanu Kohli
SK
Shin
Daniel B
DB
Wang
Xingmei
X
Margolis
David J
DJ
Strom
Brian L
BL
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011565:Psoriasis / Q000401:mortality* / Q000503:physiopathology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index