AT THE EADV CONGRESS
GENEVA (FRONTLINE MEDICAL NEWS) – Psoriasis patients are roughly two-thirds more likely to die of alcohol-related causes than their peers in the general population, Rosa Parisi, PhD, reported at the annual congress of the European Academy of Dermatology and Venereology.
Indeed, alcohol-related mortality appears to be an important contributor to the long-recognized elevated risk of premature mortality in patients who’ve been diagnosed with psoriasis, according to Dr. Parisi of the University of Manchester (England), who presented the results of a retrospective cohort study of alcohol-related deaths. The reasons for psoriasis patients’ increased risk of early mortality have been unclear, although it’s well established that psoriasis is associated with increased rates of unhealthy behaviors, including smoking and high alcohol consumption.
But another study Dr. Parisi presented at the congress provided evidence that even though psoriasis patients have a higher prevalence of diagnosed psychiatric comorbidities than their matched peers in the general population, they have a below-average risk of suicide and no increase in deliberate self-harm. In fact, diagnosis of psoriasis at age 40 or older was actually strongly protective in her large study, with an associated 62% lower suicide rate than in controls.
The study of alcohol-related deaths utilized a database of 398 primary care practices in England. The study population consisted of 55,537 patients diagnosed with psoriasis in 1998-2014 and 854,314 controls without psoriasis who were matched based on age, sex, and membership in the same primary care practice.
During a median 4.4 years of follow-up, the rate of deaths directly attributable to alcohol consumption was 4.8 per 10,000 person-years in the psoriasis group and 2.5 per 10,000 person-years in controls. Nearly two-thirds of the alcohol-related deaths were recorded as due to alcoholic liver disease and 24% to hepatic fibrosis and cirrhosis; 8% were attributed to mental and behavioral disorders due to alcohol.
In an analysis adjusted for socioeconomic status, the risk for alcohol-related death was increased 1.58-fold in the psoriasis group, compared with controls. Upon exclusion of all subjects who’d been on methotrexate on the grounds that the drug interacts with alcohol to accelerate liver damage, having psoriasis was associated with a 1.66-fold increased risk of alcohol-related death.
Such deaths occurred in women with psoriasis at a median age of 55 – a full 5 years younger than alcohol-related deaths in nonpsoriatic women. The age gap was smaller in men.
Medical records indicated that 82.2% of psoriasis patients who died of alcohol-related causes had previously been coded by their primary care practitioner as a heavy drinker, as were 75.5% of those without psoriasis who died of similar causes. Yet fewer than 11% of the psoriasis patients and controls who experienced alcohol-related mortality had ever received a prescription for a medication for alcohol dependence, such as disulfiram . Psychologic support for alcohol dependence had been offered within the primary care practices for only 19.7% of psoriasis patients with an alcohol-related death and 14.4% of controls.
These statistics contain an important message for clinicians, Dr. Parisi said.
“Alcohol misuse often remains unidentified and undertreated in primary care. Health care practitioners should be more aware of the psychologic difficulties of people with psoriasis. The Alcohol Use Disorders Identification Test screening tool , which has been developed by the World Health Organization, should be implemented in both primary and secondary care to detect alcohol misuse in psoriasis patients,” she asserted.
Elsewhere at the meeting, she presented a study on the risks of suicide and nonfatal deliberate self-harm among psoriasis patients. She utilized the same database of 398 English primary care medical practices. This analysis included 56,961 psoriasis patients and 876,919 matched controls.
The suicide rate was 1.1 per 10,000 person-years in the psoriasis group and 1.5 per 10,000 person-years in controls. In a proportional hazard analysis adjusted for socioeconomic status, psoriasis patients were at a significant 41% lower risk of suicide than their nonpsoriatic peers. Breaking down the data further based upon age at diagnosis of psoriasis, patients diagnosed before age 40 were at a nonsignificant 8% lower risk of suicide, while those diagnosed at age 40 years or older experienced a highly significant 62% reduction in risk of suicide, compared with controls.
This was the case even though the psoriasis group had a significantly greater prevalence of psychiatric comorbidities overall, by a margin of 29.2% versus 26.4%.
The analysis of risk of nonfatal deliberate self-harm was done after excluding all individuals in the suicide study who had a baseline history of self-harm. This resulted in a study population of 54,709 psoriasis patients and 813,699 controls matched by age, sex, and primary care practice. Bottom line: There was no evidence of an association between having a diagnosis of psoriasis and nonfatal deliberate self-harm. The rates – 18.9 events per 10,000 person-years in the psoriasis group and 16.3 per 10,000 person-years in controls – were closely similar after adjusting for socioeconomic status.
Simultaneous with her EADV presentation on alcohol-related deaths in psoriasis patients, Dr. Parisi’s study was published online (JAMA Dermatol. 2017 Sep 15. doi: 10.1001/jamadermatol.2017.3225 ).
She reported having no financial conflicts of interest regarding her presentations.