Patients with psoriasis have approximately a 60% greater risk of mortality due to alcohol-related causes compared with those without psoriasis, according to a study published in JAMA Dermatology.
Rosa Parisi, PhD, from the Centre for Pharmacoepidemiology and Drug Safety at the University of Manchester, and colleagues conducted an incident cohort study of patients diagnosed with psoriasis using the UK Clinical Practice Research Datalink (CPRD) as well as Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality records. The psoriasis cohort included adult patients (aged 18 years and older) who identified in the CPRD with their first diagnosis of psoriasis between January 1, 1998, and March 3, 2014. The index date was set as the first diagnosis recorded during the study window. Patients with psoriasis were matched with up to 20 comparison patients without psoriasis regarding age, sex, and general practice.
Alcohol consumption level was categorized as follows: nondrinkers, former drinkers, occasional drinkers, moderate drinkers, and heavy drinkers, according to UK guidelines on alcohol consumption. Cause-specific mortality was determined through patient electronic health records (primary care: CPRD; secondary care: HES) with ONS mortality records.
A total of 55,537 patients with incident psoriasis and 854,314 patients in the matched comparison cohort met the eligibility criteria and were included in the analysis (median age, 47 years). At baseline, the psoriasis cohort had a higher prevalence of being a heavy drinker (9.3%) vs the comparison cohort (7.0%). During a median of 4.4 years of follow-up, 152 alcohol-related deaths occurred in the psoriasis cohort and 1,118 in the comparison cohort.
The alcohol-related death rate per 10,000 person-years was higher for the psoriasis cohort (4.8) vs the comparison cohort (2.5). Patients with psoriasis who died from alcohol-related causes were on average 3 years younger than those without psoriasis who died from these causes (median age at death, 55 vs 58 years, respectively). Women with psoriasis died from alcohol-related causes about 5 years younger than women without psoriasis.
The predominant causes of alcohol-related death were alcoholic liver disease (65.1%), fibrosis and cirrhosis of the liver (23.7%), and mental and behavioral disorders due to alcohol (7.9%). These 3 causes together accounted for 147 (96.7%) of the 152 deaths among the individuals diagnosed with psoriasis.
“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,” the authors concluded.
Parisi R, Webb RT, Carr MJ, et al. Alcohol-related mortality in patients with psoriasis: A population-based cohort study. JAMA Dermatol. 2017 Sep 15. doi: 10.1001/jamadermatol.2017.3225