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. 2017 Dec 1;153(12):1256-1262.
doi: 10.1001/jamadermatol.2017.3225.

Alcohol-Related Mortality in Patients With Psoriasis: A Population-Based Cohort Study

Rosa Parisi  1 , Roger T Webb  2 , Matthew J Carr  2 , Kieran J Moriarty  3 , C Elise Kleyn  4 , Christopher E M Griffiths  4   5 , Darren M Ashcroft  1   5   6
Affiliations

Alcohol-Related Mortality in Patients With Psoriasis: A Population-Based Cohort Study

Rosa Parisi et al. JAMA Dermatol. .

Abstract

Importance: People diagnosed with psoriasis have an increased risk of premature mortality, but the underlying reasons for this mortality gap are unclear.

Objective: To investigate whether patients with psoriasis have an elevated risk of alcohol-related mortality.

Design, setting, and participants: An incident cohort of patients with psoriasis aged 18 years and older was delineated for 1998 through 2014 using the Clinical Practice Research Datalink (CPRD) and linked to Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality records. Patients with psoriasis were matched with up to 20 comparison patients without psoriasis on age, sex, and general practice.

Main outcomes and measures: Alcohol-related deaths were ascertained via the Office for National Statistics mortality records. A stratified Cox proportional hazard model was used to estimate the cause-specific hazard ratio for alcohol-related death, with adjustment for socioeconomic status.

Results: The cohort included 55 537 with psoriasis and 854 314 patients without psoriasis. Median (interquartile) age at index date was 47 (27) years; 408 230 of total patients (44.9%) were men. During a median (IQR) of 4.4 (6.2) years of follow-up, the alcohol-related mortality rate was 4.8 per 10 000 person-years (95% CI, 4.1-5.6; n = 152) for the psoriasis cohort, vs 2.5 per 10 000 (95% CI, 2.4- 2.7; n = 1118) for the comparison cohort. The hazard ratio for alcohol-related death in patients with psoriasis was 1.58 (95% CI, 1.31-1.91), and the predominant causes of alcohol-related deaths were alcoholic liver disease (65.1%), fibrosis and cirrhosis of the liver (23.7%), and mental and behavioral disorders due to alcohol (7.9%).

Conclusions and relevance: People with psoriasis have approximately a 60% greater risk of dying due to alcohol-related causes compared with peers of the same age and sex in the general population. This appears to be a key contributor to the premature mortality gap. These findings call for routine screening, identification and treatment, using the Alcohol Use Disorders Identification Test (AUDIT-C) in both primary and secondary care to detect alcohol consumption and misuse among people diagnosed with psoriasis.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Kleyn has received honoraria and/or research funding from Pfizer, Janssen, Johnson & Johnson and honoraria from AbbVie, Amgen, Galderma, Leo Pharma, and GSK-Stiefel, Eli Lilly. Dr Griffiths has received honoraria and/or research grants from AbbVie, Actelion, Almirall, Amgen, Celgene, Galderma, Leo Pharma, Eli Lilly, GSK-Stiefel, Janssen, MSD, Novartis, Pfizer, Sandoz, Sun Pharmaceuticals and USB Pharma. Dr Ashcroft has received grant funding from AbbVie and served on advisory boards for Pfizer and GSK. No other conflicts are reported.

Figures

Figure.
Figure.. Cumulative Incidence Functions for Alcohol-Related Death and Other Causes of Death
The figure shows the cumulative incidence functions for (A) alcohol-related death and (B) other causes of death in the psoriasis and comparison cohorts across the maximum 16 years of follow-up.
See this image and copyright information in PMC

References

    1. Parisi R, Symmons DPM, Griffiths CEM, Ashcroft DM; Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team . Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. 2013;133(2):377-385. - PubMed
    1. Springate DA, Parisi R, Kontopantelis E, Reeves D, Griffiths CEM, Ashcroft DM. Incidence, prevalence and mortality of patients with psoriasis: a U.K. population-based cohort study. Br J Dermatol. 2017;176(3):650-658. - PMC - PubMed
    1. World Health Organization Global report on psoriasis. http://apps.who.int/iris/handle/10665/204417. Accessed June 16, 2017.
    1. McAleer MA, Mason DL, Cunningham S, et al. . Alcohol misuse in patients with psoriasis: identification and relationship to disease severity and psychological distress. Br J Dermatol. 2011;164(6):1256-1261. - PubMed
    1. Kirby B, Richards HL, Mason DL, Fortune DG, Main CJ, Griffiths CEM. Alcohol consumption and psychological distress in patients with psoriasis. Br J Dermatol. 2008;158(1):138-140. - PubMed

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