Risk of Mortality of people with Psoriasis and Psoriatic arthritis in Taiwan: A Nationwide Cohort Study

Objective Residual confounding effects and disease severity attributed to controversial results in studies of psoriatic disease (PsD) and mortality. We aimed to evaluate the risk of mortality in incident PsD patients, compared to a matched controls from the population. Methods We used the nationwide, population-based insurance claim datasets in Taiwan from 2010-2018. Incident cases of PsD were identified by ICD codes. A non-exposed cohort was established through propensity score matching. Deaths were identified via the National Mortality Database. We evaluated the risk of all-cause mortality in PsD compared to the propensity score matched (PSM) non-exposed individuals using COX regression. The mortality risk was evaluated in patients with more severe disease stratified by systemic therapies use and having Psoriatic arthritis (PsA). Results 108,642 incident PsD (40.17% women) and equal number of PSM matched non-PsD individuals were identified. Compared to the age and sex matched controls, there was a higher risk of mortality among patients with PsD (adjusted HR=1.73, 95% CI: 1.68-1.77, p<0.0001). After propensity score matching, we found an attenuated but persistent higher risk of mortality in PsD compared to controls (adjusted HR=1.20, 95% CI: 1.16-1.24). There was a trend of higher mortality in patients exposed to biologic therapies, but not for PsA. Conclusion There was an increased risk of all-cause mortality in individuals with PsD compared to non-PSD individuals before and after propensity score matching and adjustment for co-morbidities. The risk of mortality was higher in patients with PsO but not in patients with PsA as compared to controls.