title: The impact of age on psoriasis health care in Germany.
abstract: BACKGROUND
  Inequality between age groups has been demonstrated in the prescription of biologics, yet systematic real-world data about age-related differences in psoriasis care are missing.
  
  
  OBJECTIVE
  To investigate disparities in psoriasis characteristics by age groups and to identify potential impact on psoriasis health care.
  
  
  METHODS
  Data analysis included 3615 patients from the German psoriasis registry PsoBest, which observes adult patients with moderate-to-severe psoriasis or psoriatic arthritis (PsA) on systemic treatment over a time period of 10 years.
  
  
  RESULTS
  With 2376 participants (65.7%), the majority of patients was assigned to the age group 35-64, followed by 776 (21.4%) and 463 (12.8%) for the age groups 18-34 and 65+, respectively. Psoriasis vulgaris was the most frequent form of psoriasis with nearly 90% patients affected. Appearance of psoriasis forms did not differentiate significantly between the age groups except for erythrodermic psoriasis, which was more frequent in the elderly than in patients aged 35-64 (1.9%, P ≤ 0.048). Nail psoriasis appeared significantly more often in patients aged 35-64 (55.5%, P ≤ 0.001) and also showed the highest number of nails involved (6.9 ± 3.3). PsA was less frequent in the age group 18-34 (9.5%, P ≤ 0.001). This group showed the highest rate of scalp psoriasis (85.8%) compared to the elder age groups (P ≤ 0.001). Biologicals were used significantly less in younger patients (16.2%) compared to the age groups 35-64 (23.9%, P ≤ 0.001) and 65+ (21.8%, P ≤ 0.042).
  
  
  CONCLUSIONS
  Middle-aged patients show higher rates of PsA and nail psoriasis, which may explain age-dependent disparities in health care including the use of systemic treatment.
authors.affiliation: Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Trettel
authors.affiliation: Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Spehr
authors.affiliation: Department of Dermatology, University Clinic Essen, Essen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Körber
authors.affiliation: Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Augustin
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009260:Nail Diseases / Q000628:therapy; D011565:Psoriasis / Q000473:pathology / Q000628:therapy*; D012042:Registries; D012720:Severity of Illness Index; D055815:Young Adult