Risk of Hospitalisation and Death due to Infection in People with Psoriasis: a Population-based Cohort Study using the Clinical Practice Research Datalink

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Abstract

BACKGROUND: Psoriasis is associated with risk factors for serious infections, but the independent relationship between psoriasis and serious infection is as yet unclear.

OBJECTIVE: To determine whether people with psoriasis have a higher risk of hospitalisation due to any infection; respiratory infections; soft tissue and skin infections; or a higher risk of death due to infection.

METHODS: We conducted a cohort study of people (≥18) with psoriasis using the UK Clinical Practice Research Datalink (CPRD GOLD) linked to Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality records between 01/04/2003 and 31/12/2016, and matched with up to 6 comparators on age, sex, and general practice. Hospitalisation was ascertained from HES records; death was ascertained from ONS mortality records. Stratified Cox proportional hazard models were estimated, with stepwise adjustment in different models for potential confounders or mediators between psoriasis and serious infection.

RESULTS: 69,312 people with psoriasis and 338,598 comparators were followed up for a median (inter-quartile range) of 4.9 (5.9) and 5.1 (6.3) years respectively. People with psoriasis had a higher incidence rate of serious infection (20.5/1000 person-years, 95% CI 20.0-21.0, n=7629) compared with those without psoriasis (16.1/1000 person-years, 95% CI 15.9-16.3, n=30756). The fully adjusted hazard ratio for the association between psoriasis and serious infection was 1.36 (95%CI 1.31-1.40), with results similar across the other outcomes.

CONCLUSIONS: Psoriasis is associated with a small increase in the risk of serious infection. Further research is needed to understand how psoriasis predisposes to a higher risk of infection.

Original languageEnglish
JournalThe British journal of dermatology
Early online date28 Mar 2020
DOIs
Publication statusPublished - 2020

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