All-cause and cause-specific mortality in psoriasis: A systematic review and meta-analysis

Abstract

Background: An overview of mortality risk associated with psoriasis is lacking.

Objective: To perform a systematic review and meta-analysis of mortality risk in psoriasis.

Methods: We included studies reporting all-cause or cause-specific mortality risk estimates in psoriasis patients compared with general population or subjects free of psoriasis. We calculated pooled relative risks (RRs) and 95% confidence intervals (CIs).

Results: We included 12 studies. The pooled RRs for all-cause mortality were 1.21 (95% CI 1.14-1.28) in psoriasis, 1.13 (95% CI 1.09-1.16) in mild psoriasis, and 1.52 (95% CI 1.35-1.71) in severe psoriasis. The pooled RRs for cardiovascular mortality were 1.15 (95% CI 1.09-1.21) in psoriasis, 1.05 (95% CI 0.92-1.20) in mild psoriasis, and 1.38 (95% CI 1.09-1.74) in severe psoriasis. For noncardiovascular causes, mortality risk from liver disease, kidney disease, and infection was significantly increased in psoriasis, regardless of disease severity. The mortality risk in liver and kidney disease was the highest. There was also a significantly increased mortality risk associated with neoplasms in severe psoriasis patients and chronic lower respiratory disease in all and mild psoriasis patients.

Limitations: Although associations were consistent, their magnitude was heterogenous.

Conclusion: Psoriasis is associated with an increased risk for mortality from all causes (in a dose-response manner with disease severity) and from several specific causes.

Keywords: cardiovascular disease; cause of death; infectious disease; kidney disease; liver disease; malignancy; mortality; psoriasis; respiratory disease; systematic review.