Association of Psoriasis With Comorbidity Development in Children With Psoriasis

Abstract

IMPORTANCE Children with psoriasis are at increased risk for comorbidities. Many children with psoriasis are also overweight or obese; it is unknown whether the increased risk of comorbidities in these children is independent of obesity. OBJECTIVE To determine the risk of elevated lipid levels (hyperlipidemia/hypertriglyceridemia), hypertension, metabolic syndrome, polycystic ovarian syndrome, diabetes, nonalcoholic liver disease, and elevated liver enzyme levels in children with and without psoriasis, after accounting for obesity. DESIGN, SETTING, AND PARTICIPANTSThis was a retrospective cohort study of claims data from Optum Laboratories Data Warehouse (includes 150 million privately insured and Medicare enrollees). A cohort of 29 957 children with psoriasis (affected children) and an age-, sex-, and race-matched comparator cohort of 29 957 children without psoriasis were identified and divided into 4 groups: (1) nonobese, without psoriasis (reference cohort);(2) nonobese, with psoriasis; (3) obese, without psoriasis; and (4) obese, with psoriasis. MAIN OUTCOMES AND MEASURES Risk of developing comorbidities (Cox proportional hazards regression). RESULTSThe overall mean (SD) age of those included in the cohort was 12.0 (4.4) years, and 16 034 (53.5%) were girls. At baseline, more affected children were obese (862 [2.9%] vs 463 [1.5%]; P < .001 for all comparisons). Children with psoriasis were significantly more likely to develop each of the comorbidities than those without psoriasis (P < .01). Obesity was a strong risk factor for development of each comorbidity, even in those without psoriasis (hazard ratios [HRs] ranging from 2.26 to 18.11). The risk of comorbidities was 40% to 75% higher among nonobese children with vs without psoriasis: elevated lipid levels (HR, 1.42; 95% CI, 1.25-1.62), hypertension (HR, 1.64; 95% CI, 1.40-1.93), diabetes (HR, 1.58; 95% CI, 1.27-1.95), metabolic syndrome (HR, 1.62; 95% CI, 1.13-2.33), polycystic ovarian syndrome (HR, 1.49; 95% CI, 1.18-1.88), nonalcoholic liver disease (HR, 1.76; 95% CI, 1.16-2.65), and elevated liver enzyme levels (HR, 1.46; 95% CI, 1.27-1.67). Except for hypertension (P = .03), no significant interaction occurred between psoriasis and obesity on the risk of comorbidities.CONCLUSIONS AND RELEVANCE Children with psoriasis are at greater risk of developing obesity, hyperlipidemia, hypertension, diabetes, metabolic syndrome, polycystic ovarian syndrome, nonalcoholic liver disease, and elevated liver function enzyme levels than children without psoriasis. While psoriasis is a small independent risk factor for the development of these comorbidities, obesity is a much stronger contributor to comorbidity development in children with psoriasis.

High Blood Pressure in Normal-weight Children with Psoriasis

“…Our study investigating blood pressure in normal-weight children with psoriasis shows an association between psoriasis and high blood pressure independently of over-weight status. Similar results, suggesting psoriasis as an independent risk factor for the development of high blood pressure, have been reported recently from a study investigating a large retrospective database of children with psoriasis (6). Such findings suggest the need to assess comorbidities in all children with psoriasis (i.e.…”

“…Both adults and children with psoriasis are at risk for comorbidities, including obesity, hypertension, hyperlipidaemia, diabetes mellitus, metabolic syndrome, non-alcoholic fatty liver disease (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Since obesity is a known risk factor for most of these comorbidities, it would be useful to determine whether psoriasis is an independent risk factor for some or all of them (6).…”

“…There is some evidence of psoriasis as an independent risk factor for comorbidities (1,6), but most of the studies are retrospective or have limitations due to interinstitutional variations in data collecting methodologies, data interpretation, different populations studied or limited number of patients.…”

Cohort profile: the clinical ‘Psoriasis in Adolescents’ (PIA) cohort in Denmark

“…In adults, psoriasis has been shown to be associated with a wide range of comorbidities, predominantly cardiovascular and metabolic diseases, and also depression and anxiety and autoimmune disorders including inflammatory bowel disease 18–22. Previous studies on children and adolescents with psoriasis have found some of these comorbidities, or risk factors thereof, to be increased 11 23–26. Since these studies have mainly been done in highly selected hospital-treated populations, with small sample sizes, or by retrospectively reviewing, for example, patient records, we wished to investigate paediatric psoriasis in a more general population, and also to include psoriasis-free controls for comparison, with the possibility of prospective data collection 11 23–49.…”

P wave dispersion, Tpeak–Tend interval, and Tp-e/QT ratio in children with psoriasis

“…Several studies demonstrate that adult patients with psoriasis have been linked to cardiovascular risk factors including hypertension, obesity, diabetes, dyslipidemia, atherosclerosis, and more importantly elevated prevalence of cardiovascular disease and cardiovascular mortality. 4 Psoriasis and atherosclerosis have similar inflammatory mechanisms, and it appears that a significant overlap. In literature search, cardiovascular risk in childhood psoriasis is more limited, and only a few studies in literature have examined the association between paediatric psoriasis and related rhythm abnormalities and conduction disturbances.…”