| Summary: | 碩士 === 國立臺灣大學 === 流行病學與預防醫學研究所 === 99 === Background
Psoriasis is a chronic inflammatory disease which affects 0.19% of Taiwanese population. It has been known that psoriasis is associated with several co-morbidities including obesity, diabetes, cardiovascular disease, cancer and depression. In addition, patients with psoriasis have higher rates of smoking and drinking alcohol. All these co-morbidities may lead to high risks of mortality in patients. So far, several studies related to mortality and psoriasis showed that patients with psoriasis had an increased risk of death. Patients with severe psoriasis were found to have higher risk of death from cardiovascular disease, cancer, liver disease, diabetes and dementia. However, the data related to Asian population is limited.
Objectives
To describe all-cause and cause-specific mortality in patients with psoriasis and determine the risk for mortality in psoriasis
Material and method
We perform a hospital-based cohort study from 2001 to 2008 of patients aged of more than 20 years and less than 65 years. Survival status, date of death and cause of death were ascertained by linking the study cohort with the National Register of Deaths Database of Taiwan. All-cause and cause-specific standardized mortality ratios (SMRs) were estimated. Besides, age- and sex-adjusted Cox proportional hazards models were used to determine the risk of mortality.
Results
We observed 209 deaths in 5940 patients. The all-cause standardized mortality ratio (SMR) was 1.55 (95% confidence interval [CI], 1.35-1.77). In the analysis of causes of death, the SMRs for death due to diabetes( 2.32; 95%CI, 1.46-3.68), cardiovascular disease(2.20 ;95%CI, 1.48-3.29), liver disease (2.74; 95%CI, 1.85-4.05), malignancy (1.34; 95%CI, 1.05-1.73)and kidney disease (3.30, 95%CI: 1.77-6.13) were significantly higher. Severe psoriasis is not associated with mortality in patients who were followed less than 4 years (Hazard ratio:0.82; 95%CI, 0.55-1.22). However, the risk of severe psoriasis increased for mortality in those followed for more than 4 years (HR:1.83; 95%CI, 1.18-2.83).
Conclusion
The overall mortality among patients with psoriasis was 1.5 times greater than that of the general population. Patients with psoriasis have higher risk of mortality from diabetes, cardiovascular disease, liver disease, malignancy and kidney disease. Severe psoriasis is associated with an increased risk of death in patients who were followed more than 4 years.
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