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Results From a Population-Based Study

Joel M. Gelfand, MD, MSCE; Andrea B. Troxel, ScD; James D. Lewis, MD, MSCE; Shanu Kohli Kurd, MHS; Daniel B. Shin, BA; Xingmei Wang, MS; David J. Margolis, MD, PhD; Brian L. Strom, MD, MPH

Arch Dermatol. 2007;143(12):1493-1499.

Objective  To determine the risk of mortality in patients with psoriasis.

Design  Cohort study.

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

Patients  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.

Main Outcome Measure  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).

Conclusion  Severe but not mild psoriasis is associated with an increased risk of death.

Author Affiliations: Center for Clinical Epidemiology and Biostatistics (Drs Gelfand, Troxel, Lewis, Margolis, and Strom and Ms Wang), Department of Biostatistics and Epidemiology (Drs Troxel, Lewis, Margolis, and Strom), and Department of Dermatology (Drs Gelfand and Margolis, Ms Kurd, and Mr Shin), University of Pennsylvania School of Medicine, Philadelphia.

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