The risk of mortality in patients with psoriasis - Results from a population-based study

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.