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Alcohol-Related Mortality in Patients With Psoriasis: A Population-Based Cohort Study.
JAMA Dermatol. 2017 12 01; 153(12):1256-1262.JD

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.

Authors+Show Affiliations

Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, England.Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, England.Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, England.Bolton NHS Foundation Trust, Bolton, England.Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, England.Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, England. NIHR Manchester Biomedical Research Centre, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, England.Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, England. NIHR Manchester Biomedical Research Centre, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, England. NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, England.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28914955

Citation

Parisi, Rosa, et al. "Alcohol-Related Mortality in Patients With Psoriasis: a Population-Based Cohort Study." JAMA Dermatology, vol. 153, no. 12, 2017, pp. 1256-1262.
Parisi R, Webb RT, Carr MJ, et al. Alcohol-Related Mortality in Patients With Psoriasis: A Population-Based Cohort Study. JAMA Dermatol. 2017;153(12):1256-1262.
Parisi, R., Webb, R. T., Carr, M. J., Moriarty, K. J., Kleyn, C. E., Griffiths, C. E. M., & Ashcroft, D. M. (2017). Alcohol-Related Mortality in Patients With Psoriasis: A Population-Based Cohort Study. JAMA Dermatology, 153(12), 1256-1262. https://doi.org/10.1001/jamadermatol.2017.3225
Parisi R, et al. Alcohol-Related Mortality in Patients With Psoriasis: a Population-Based Cohort Study. JAMA Dermatol. 2017 12 1;153(12):1256-1262. PubMed PMID: 28914955.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Alcohol-Related Mortality in Patients With Psoriasis: A Population-Based Cohort Study. AU - Parisi,Rosa, AU - Webb,Roger T, AU - Carr,Matthew J, AU - Moriarty,Kieran J, AU - Kleyn,C Elise, AU - Griffiths,Christopher E M, AU - Ashcroft,Darren M, PY - 2017/9/16/pubmed PY - 2017/12/23/medline PY - 2017/9/16/entrez SP - 1256 EP - 1262 JF - JAMA dermatology JO - JAMA Dermatol VL - 153 IS - 12 N2 - 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. SN - 2168-6084 UR - https://www.unboundmedicine.com/medline/citation/28914955/Alcohol_Related_Mortality_in_Patients_With_Psoriasis:_A_Population_Based_Cohort_Study_ DB - PRIME DP - Unbound Medicine ER -