Psoriasis Mortality Rises with Alcohol

The risk of dying as a result of alcohol-related causes is about 60% greater in persons who have psoriasis than in their peers of the same age and sex in the general population.

Alcohol consumption appears to be a key contributor to the premature mortality gap in persons with psoriasis.

Researchers at the University of Manchester in the United Kingdom delineated an incident cohort of patients with psoriasis aged 18 years and older using the Clinical Practice Research Datalink and linked them to Hospital Episode Statistics and Office for National Statistics mortality records. Patients who had psoriasis were matched on age, sex, and general practice with up to 20 comparison patients who did not.

Some findings:

• During a median (interquartile) of 4.4 (6.2) years of follow-up, the alcohol-related mortality rate was 4.8 per 10,000 person-years for the psoriasis cohort vs 2.5 per 10,000 for the comparison cohort.

• The hazard ratio for alcohol-related death in patients with psoriasis was 1.58 compared with patients without psoriasis.

• Patients with psoriasis died from alcohol-related causes on average 3 years younger than those without psoriasis who died from these causes.

• Women with psoriasis died from alcohol-related causes at about 5 years younger than women without psoriasis who died from these causes.

• The incidence of alcohol-related mortality increased much more rapidly during follow-up in patients with psoriasis.

• 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 caused by alcohol (7.9%).

• Together these 3 causes accounted for 96.7% of the deaths among the patients with a diagnosis of psoriasis.

“Excessive alcohol consumption is recognized in as many as one-third of patients with moderate to severe psoriasis,” the researchers noted. “Furthermore, there is a correlation between increased alcohol intake and extent of body surface area involvement by psoriasis.”

The investigators suggested that health care practitioners who have responsibility for the care of patients with psoriasis should be more aware of the psychological difficulties they face. “Patients with increased alcohol intake may also report significantly higher levels of anxiety, depression, and psychosocial challenges,” they stated. “Consequently, alcohol misuse may be considered as a maladaptive behavior, used by affected individuals to manage their psychological distress.”

Because of the elevated risk of alcohol-related mortality found in persons with psoriasis, the authors recommended routine screening, identification, and treatment with use of the simple Alcohol Use Disorders Identification Test (AUDIT-C) to detect alcohol consumption and misuse among these patients.

They reported their findings in the September 15 online edition of JAMA Dermatology.

References:

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. [Epub ahead of print]