All-Cause and Cause-Specific Mortality in Patients with Psoriasis in Taiwan: A Nationwide Population-Based Study

Abstract

Asian population-based data evaluating all-cause mortality and cause-specific mortality in patients with psoriasis are limited. This study aimed to evaluate the risk of all-cause mortality (stratified according to onset status, disease severity, and concomitant psoriatic arthritis) and cause-specific mortality in patients with psoriasis. Our study cohort consisted of 80,167 patients with newly diagnosed psoriasis between 2001 and 2012 in the National Health Insurance Database. Vital status and cause of death were ascertained from the National Death Registry of Taiwan. All-cause and cause-specific crude mortality rates and standardized mortality ratios were estimated. A total of 7,198 deaths were identified during the follow-up period (508,505 person-years). The standardized mortality ratios were 1.53 for severe psoriasis (95% confidence interval = 1.45-1.60), 1.47 for early-onset psoriasis (95% confidence interval = 1.34-1.61), and 1.47 for patients with psoriatic arthritis (95% confidence interval = 1.36-1.58). In the cause-specific mortality analysis, the absolute and excess risks of death were highest for malignancies (3.6 and 1.57 deaths per 1,000 patient-years, respectively) and circulatory system diseases (3.0 and 1.44 deaths per 1,000 patient-years, respectively). Patients with severe psoriasis, early-onset psoriasis, and psoriatic arthritis had higher all-cause mortality risks. In particular, patients with psoriasis had higher excess risks of mortality from malignancies and circulatory system diseases.

Cause‐specific mortality in patients with psoriasis and psoriatic arthritis

“…Absolute and excess risks in these patients with psoriasis were highest for neoplasms; diseases of the digestive, circulatory and respiratory systems; and other diseases of the circulatory system. These findings are consistent with previous studies demonstrating circulatory system diseases and cancer to be among the leading causes of mortality in patients with severe psoriasis . The current study also showed that more patients with psoriasis than controls died at a younger age, as shown previously …”

The role of the interleukin‐23/Th17 pathway in cardiometabolic comorbidity associated with psoriasis

“…1 Cardiovascular disease deserves special mention in psoriasis, as per results reported in large-scale epidemiological studies. CVD constitutes the first or second cause of mortality (after malignancies) among psoriasis patients, [44][45][46] and the risk is higher among severe patients. 44,45 Duration has also been associated with CVD risk.…”

“…44,45 Duration has also been associated with CVD risk. 1,47 In terms of excess mortality, CVD was attributed globally an excess rate of 1.44 (95% CI: 1.43-1.45) per 1000 person-years; 46 in absolute terms CVD is the main driver of excess mortality in psoriasis. 45 Consistent with these findings, psoriasis patients are at higher risk of cardiovascular events, in particular those with severe disease (RR to general population ranged 1.70-3.04; 1.38-1.59; and 1.37-1.39, for myocardial infarction, stroke and CV mortality, respectively).…”

Incidence and prevalence of psoriasis in Israel between 2011 and 2017

“…7 While the predominance of early-onset psoriasis was confirmed in samples from dermatology departments, outpatient clinics and self-reported patient surveys, 11,[22][23][24][25][26] recent population-based estimates suggested that late-onset psoriasis was the more common form. [27][28][29] The high frequency of late-onset psoriasis among incident cases probably reflects the underlying population age distribution, with late-onset psoriasis more common as the general population becomes older. The discrepancy could also be explained by over-representation of the more severe early-onset presentation in studies of highly selected populations.…”