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1.
Gelfand  JM, Weinstein  R, Porter  SB, Neimann  AL, Berlin  JA, Margolis  DJ.  Prevalence and treatment of psoriasis in the United Kingdom: a population-based study.  Arch Dermatol. 2005;141(12):1537-1541.PubMedGoogle ScholarCrossref
2.
Stern  RS, Nijsten  T, Feldman  SR, Margolis  DJ, Rolstad  T.  Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction.  J Investig Dermatol Symp Proc. 2004;9(2):136-139.PubMedGoogle ScholarCrossref
3.
Gelfand  JM, Neimann  AL, Shin  DB, Wang  X, Margolis  DJ, Troxel  AB.  Risk of myocardial infarction in patients with psoriasis.  JAMA. 2006;296(14):1735-1741.PubMedGoogle ScholarCrossref
4.
Gelfand  JM, Dommasch  ED, Shin  DB,  et al.  The risk of stroke in patients with psoriasis.  J Invest Dermatol. 2009;129(10):2411-2418.PubMedGoogle ScholarCrossref
5.
Ahlehoff  O, Gislason  GH, Jørgensen  CH,  et al.  Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish Nationwide Cohort Study.  Eur Heart J. 2012;33(16):2054-2064.PubMedGoogle ScholarCrossref
6.
Prodanovich  S, Kirsner  RS, Kravetz  JD, Ma  F, Martinez  L, Federman  DG.  Association of psoriasis with coronary artery, cerebrovascular, and peripheral vascular diseases and mortality.  Arch Dermatol. 2009;145(6):700-703.PubMedGoogle ScholarCrossref
7.
Brauchli  YB, Jick  SS, Meier  CR.  Psoriasis and the risk of incident diabetes mellitus: a population-based study.  Br J Dermatol. 2008;159(6):1331-1337.PubMedGoogle ScholarCrossref
8.
Qureshi  AA, Choi  HK, Setty  AR, Curhan  GC.  Psoriasis and the risk of diabetes and hypertension: a prospective study of US female nurses.  Arch Dermatol. 2009;145(4):379-382.PubMedGoogle ScholarCrossref
9.
Mehta  NN, Azfar  RS, Shin  DB, Neimann  AL, Troxel  AB, Gelfand  JM.  Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database.  Eur Heart J. 2010;31(8):1000-1006.PubMedGoogle ScholarCrossref
10.
Abuabara  K, Azfar  RS, Shin  DB, Neimann  AL, Troxel  AB, Gelfand  JM.  Cause-specific mortality in patients with severe psoriasis: a population-based cohort study in the U.K.  Br J Dermatol. 2010;163(3):586-592.PubMedGoogle ScholarCrossref
11.
Armstrong  AW, Harskamp  CT, Armstrong  EJ.  Psoriasis and the risk of diabetes mellitus: a systematic review and meta-analysis.  JAMA Dermatol. 2013;149(1):84-91.PubMedGoogle ScholarCrossref
12.
Azfar  RS, Seminara  NM, Shin  DB, Troxel  AB, Margolis  DJ, Gelfand  JM.  Increased risk of diabetes mellitus and likelihood of receiving diabetes mellitus treatment in patients with psoriasis.  Arch Dermatol. 2012;148(9):995-1000.PubMedGoogle ScholarCrossref
13.
Yang  YW, Keller  JJ, Lin  HC.  Medical comorbidity associated with psoriasis in adults: a population-based study.  Br J Dermatol. 2011;165(5):1037-1043.PubMedGoogle ScholarCrossref
14.
Augustin  M, Reich  K, Glaeske  G, Schaefer  I, Radtke  M.  Co-morbidity and age-related prevalence of psoriasis: analysis of health insurance data in Germany.  Acta Derm Venereol. 2010;90(2):147-151.PubMedGoogle ScholarCrossref
15.
Langan  SM, Seminara  NM, Shin  DB,  et al.  Prevalence of metabolic syndrome in patients with psoriasis: a population-based study in the United Kingdom.  J Invest Dermatol. 2012;132(3, pt 1):556-562.PubMedGoogle ScholarCrossref
16.
Gulliver  W.  Long-term prognosis in patients with psoriasis.  Br J Dermatol. 2008;159(suppl 2):2-9.PubMedGoogle ScholarCrossref
17.
Kimball  AB, Gladman  D, Gelfand  JM,  et al; National Psoriasis Foundation.  National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening.  J Am Acad Dermatol. 2008;58(6):1031-1042.PubMedGoogle ScholarCrossref
18.
Lewis  JD, Schinnar  R, Bilker  WB, Wang  X, Strom  BL.  Validation studies of the health improvement network (THIN) database for pharmacoepidemiology research.  Pharmacoepidemiol Drug Saf. 2007;16(4):393-401.PubMedGoogle ScholarCrossref
19.
Seminara  NM, Abuabara  K, Shin  DB,  et al.  Validity of The Health Improvement Network (THIN) for the study of psoriasis.  Br J Dermatol. 2011;164(3):602-609.PubMedGoogle Scholar
20.
Horn  EJ, Fox  KM, Patel  V, Chiou  CF, Dann  F, Lebwohl  M.  Are patients with psoriasis undertreated? results of National Psoriasis Foundation survey.  J Am Acad Dermatol. 2007;57(6):957-962.PubMedGoogle ScholarCrossref
21.
Krueger  G, Koo  J, Lebwohl  M, Menter  A, Stern  RS, Rolstad  T.  The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient-membership survey.  Arch Dermatol. 2001;137(3):280-284.PubMedGoogle Scholar
22.
Dommasch  ED, Shin  DB, Troxel  AB, Margolis  DJ, Gelfand  JM.  Reliability, validity and responsiveness to change of the Patient Report of Extent of Psoriasis Involvement (PREPI) for measuring body surface area affected by psoriasis.  Br J Dermatol. 2010;162(4):835-842.PubMedGoogle ScholarCrossref
23.
Charlson  ME, Pompei  P, Ales  KL, MacKenzie  CR.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.  J Chronic Dis. 1987;40(5):373-383.PubMedGoogle ScholarCrossref
24.
Quan  H, Sundararajan  V, Halfon  P,  et al.  Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.  Med Care. 2005;43(11):1130-1139.PubMedGoogle ScholarCrossref
25.
Khan  NF, Perera  R, Harper  S, Rose  PW.  Adaptation and validation of the Charlson Index for Read/OXMIS coded databases.  BMC Fam Pract. 2010;11:1. doi:10.1186/1471-2296-11-1.PubMedGoogle ScholarCrossref
26.
Gelfand  JM, Troxel  AB, Lewis  JD,  et al.  The risk of mortality in patients with psoriasis: results from a population-based study.  Arch Dermatol. 2007;143(12):1493-1499.PubMedGoogle ScholarCrossref
27.
Solomon  DH, Massarotti  E, Garg  R, Liu  J, Canning  C, Schneeweiss  S.  Association between disease-modifying antirheumatic drugs and diabetes risk in patients with rheumatoid arthritis and psoriasis.  JAMA. 2011;305(24):2525-2531.PubMedGoogle ScholarCrossref
28.
Lan  CC, Ko  YC, Yu  HS,  et al.  Methotrexate reduces the occurrence of cerebrovascular events among Taiwanese psoriatic patients: a nationwide population-based study.  Acta Derm Venereol. 2012;92(4):349-352.PubMedGoogle ScholarCrossref
29.
Prodanovich  S, Ma  F, Taylor  JR, Pezon  C, Fasihi  T, Kirsner  RS.  Methotrexate reduces incidence of vascular diseases in veterans with psoriasis or rheumatoid arthritis [published correction appears in J Am Acad Dermatol. 2005;52(4):670].  J Am Acad Dermatol. 2005;52(2):262-267.PubMedGoogle ScholarCrossref
30.
Mehta  NN, Yu  Y, Saboury  B,  et al.  Systemic and vascular inflammation in patients with moderate to severe psoriasis as measured by [18F]-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT): a pilot study.  Arch Dermatol. 2011;147(9):1031-1039.PubMedGoogle ScholarCrossref
31.
Davidovici  BB, Sattar  N, Prinz  J,  et al.  Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and co-morbid conditions [published correction appears in J Invest Dermatol. 2010;130(10):2517].  J Invest Dermatol. 2010;130(7):1785-1796.PubMedGoogle ScholarCrossref
32.
Capon  F, Burden  AD, Trembath  RC, Barker  JN.  Psoriasis and other complex trait dermatoses: from Loci to functional pathways.  J Invest Dermatol. 2012;132(3, pt 2):915-922.PubMedGoogle ScholarCrossref
33.
Wang  Y, Gao  H, Loyd  CM,  et al.  Chronic skin-specific inflammation promotes vascular inflammation and thrombosis.  J Invest Dermatol. 2012;132(8):2067-2075.PubMedGoogle ScholarCrossref
34.
Miele  L, Vallone  S, Cefalo  C,  et al.  Prevalence, characteristics and severity of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis.  J Hepatol. 2009;51(4):778-786.PubMedGoogle ScholarCrossref
35.
Gisondi  P, Targher  G, Zoppini  G, Girolomoni  G.  Non-alcoholic fatty liver disease in patients with chronic plaque psoriasis.  J Hepatol. 2009;51(4):758-764.PubMedGoogle ScholarCrossref
36.
Kanada  KN, Schupp  CW, Armstrong  AW.  Association between psoriasis and viral infections in the United States: focusing on hepatitis B, hepatitis C and human immunodeficiency virus [published online May 7, 2012].  J Eur Acad Dermatol Venereol. doi:10.1111/j.1468-3083.2012.04563.x. PubMedGoogle Scholar
37.
Taglione  E, Vatteroni  ML, Martini  P,  et al.  Hepatitis C virus infection: prevalence in psoriasis and psoriatic arthritis.  J Rheumatol. 1999;26(2):370-372.PubMedGoogle Scholar
38.
Cohen  AD, Weitzman  D, Birkenfeld  S, Dreiher  J.  Psoriasis associated with hepatitis C but not with hepatitis B.  Dermatology. 2010;220(3):218-222.PubMedGoogle ScholarCrossref
39.
Weir  MR.  Microalbuminuria and cardiovascular disease.  Clin J Am Soc Nephrol. 2007;2(3):581-590.PubMedGoogle ScholarCrossref
40.
Dervisoglu  E, Akturk  AS, Yildiz  K, Kiran  R, Yilmaz  A.  The spectrum of renal abnormalities in patients with psoriasis.  Int Urol Nephrol. 2012;44(2):509-514.PubMedGoogle ScholarCrossref
41.
Szepietowski  JC, Bielicka  E, Wasik  F, Kopec  W, Szepietowski  T.  Microalbuminuria as a subclinical marker of renal impairment in subjects with psoriasis vulgaris.  J Eur Acad Dermatol Venereol. 2000;14(6):513-514.PubMedGoogle ScholarCrossref
42.
Cecchi  R, Seghieri  G, Gironi  A, Tuci  F, Giomi  A.  Relation between urinary albumin excretion and skin involvement in patients with psoriasis.  Dermatology. 1992;185(2):93-95.PubMedGoogle ScholarCrossref
43.
Madeddu  P, Ena  P, Glorioso  N, Cerimele  D, Rappelli  A.  High prevalence of microproteinuria, an early index of renal impairment, in patients with diffuse psoriasis.  Nephron. 1988;48(3):222-225.PubMedGoogle ScholarCrossref
44.
Pearce  DJ, Morrison  AE, Higgins  KB,  et al.  The comorbid state of psoriasis patients in a university dermatology practice.  J Dermatolog Treat. 2005;16(5-6):319-323.PubMedGoogle ScholarCrossref
45.
Dreiher  J, Weitzman  D, Shapiro  J, Davidovici  B, Cohen  AD.  Psoriasis and chronic obstructive pulmonary disease: a case-control study.  Br J Dermatol. 2008;159(4):956-960.PubMedGoogle ScholarCrossref
46.
Chiang  YY, Lin  HW.  Association between psoriasis and chronic obstructive pulmonary disease: a population-based study in Taiwan.  J Eur Acad Dermatol Venereol. 2012;26(1):59-65.PubMedGoogle ScholarCrossref
47.
Wu  JJ, Nguyen  TU, Poon  KY, Herrinton  LJ.  The association of psoriasis with autoimmune diseases.  J Am Acad Dermatol. 2012;67(5):924-930.PubMedGoogle ScholarCrossref
Original Investigation
October 2013

Psoriasis Severity and the Prevalence of Major Medical Comorbidity: A Population-Based Study

Author Affiliations
  • 1Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 3Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
  • 4Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 5Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
JAMA Dermatol. 2013;149(10):1173-1179. doi:10.1001/jamadermatol.2013.5015
Abstract

Importance  Despite the growing literature on comorbidity risks in psoriasis, there remains a critical knowledge gap on the degree to which objectively measured psoriasis severity may affect the prevalence of major medical comorbidity.

Objective  To examine the prevalence of major medical comorbidity in patients with mild, moderate, or severe psoriasis, classified objectively based on body surface area involvement, compared with that in patients without psoriasis.

Design, Setting, and Participants  Population-based cross-sectional study of patient data from United Kingdom–based electronic medical records; analysis included 9035 patients aged 25 to 64 years with psoriasis and 90 350 age- and practice-matched patients without psoriasis.

Main Outcomes and Measures  Prevalence of major medical comorbidity included in the Charlson comorbidity index.

Results  Among patients with psoriasis, 51.8%, 35.8%, and 12.4%, respectively, had mild, moderate, or severe disease based on body surface area criteria. The mean Charlson comorbidity index was increasingly higher in patients with mild (0.375 vs 0.347), moderate (0.398 vs 0.342), or severe psoriasis (0.450 vs 0.348) (each P < .05). Psoriasis overall was associated with higher prevalence of chronic pulmonary disease (adjusted odds ratio, 1.08; 95% CI, 1.02-1.15), diabetes mellitus (1.22; 1.11-1.35), diabetes with systemic complications (1.34; 1.11-1.62), mild liver disease (1.41; 1.12-1.76), myocardial infarction (1.34; 1.07-1.69), peptic ulcer disease (1.27; 1.03-1.58), peripheral vascular disease (1.38; 1.07-1.77), renal disease (1.28; 1.11-1.48), and rheumatologic disease (2.04; 1.71-2.42). Trend analysis revealed significant associations between psoriasis severity and each of the above comorbid diseases (each P < .05).

Conclusions and Relevance  The burdens of overall medical comorbidity and of specific comorbid diseases increase with increasing disease severity among patients with psoriasis. Physicians should be aware of these associations in providing comprehensive care to patients with psoriasis, especially those presenting with more severe disease.

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