title: Causes of mortality in patients with psoriasis in Malaysia - Evidence from the Malaysian Psoriasis Registry.
abstract: BACKGROUND
  Patients with severe psoriasis, namely those requiring phototherapy or systemic treatment, have an increased risk of death. The aim of this study was to determine the prevalence, aetiology and risk factors for mortality among adult patients aged 18 years and above with psoriasis in Malaysia.
  
  
  METHODS
  This was a retrospective study involving adult patients notified by dermatologists to the Malaysian Psoriasis Registry between July 2007 and December 2013. Data were cross-checked against the National Death Registry. Patients certified dead were identified and the cause of death was analysed. Multivariate analysis using multiple logistic regression were conducted on potential factors associated with higher risk of mortality.
  
  
  RESULTS
  A total of 419 deaths were identified among the 9775 patients notified. There were four significant risk factors for higher mortality: age>40 years (age 41-60 years old, Odds Ratio (OR) 2.70, 95%CI 1.75, 4.18; age>60 years OR 7.46, 95%CI 4.62, 12.02), male gender (OR 1.72, 95%CI 1.33,2.22), severe psoriasis with body surface area (BSA) >10% (OR 1.52, 95%CI 1.19, 1.96) and presence of at least one cardiovascular co-morbidity (OR 1.67, 95% CI 1.30, 2.14). Among the 301 patients with verifiable causes of death, the leading causes were infection (33.9%), cardiovascular disease (33.6%) and malignancy (15.9%).
  
  
  CONCLUSIONS
  Infection was the leading cause of death among psoriasis patients in Malaysia. Although cardiovascular diseases are well-known to cause significant morbidity and mortality among psoriasis patients, the role of infections and malignancy should not be overlooked.
authors.affiliation: University Malaya Medical Centre, Department of Medicine, Division of Dermatology, Lembah Pantai 59100, Kuala Lumpur, Malaysia. zhenli@ummc.edu.my.
authors.forename: Z
authors.initials: Z
authors.lastname: Kwan
authors.affiliation: Hospital Kuala Lumpur, Department of Dermatology, Kuala Lumpur, Malaysia.
authors.forename: C A
authors.initials: CA
authors.lastname: Yeoh
authors.affiliation: Hospital Kuala Lumpur, Department of Dermatology, Kuala Lumpur, Malaysia.
authors.forename: A
authors.initials: A
authors.lastname: Mohd Affandi
authors.affiliation: Hospital Kuala Lumpur, Department of Dermatology, Kuala Lumpur, Malaysia.
authors.forename: F A
authors.initials: FA
authors.lastname: Alias
authors.affiliation: National Clinical Research Centre, Biostatistic Unit, Kuala Lumpur, Malaysia.
authors.forename: M
authors.initials: M
authors.lastname: Hamid
authors.affiliation: National Clinical Research Centre, Biostatistic Unit, Kuala Lumpur, Malaysia.
authors.forename: N
authors.initials: N
authors.lastname: Baharum
authors.affiliation: University Malaya Medical Centre, Department of Medicine, Division of Dermatology, Lembah Pantai 59100, Kuala Lumpur, Malaysia.
authors.forename: A S W
authors.initials: AS
authors.lastname: Yong
authors.affiliation: Hospital Melaka, Department of Dermatology, Melaka, Malaysia.
authors.forename: R
authors.initials: R
authors.lastname: Baba