15838 Autoimmune comorbidities of psoriasis in US adults and children
Narla S, and Silverberg JI. 15838 Autoimmune comorbidities of psoriasis in US adults and children. Journal of the American Academy of Dermatology 2020; 83(6):AB48.
J Am Acad Dermatol
Background: Psoriasis is a chronic inflammatory skin disease affecting >7 million persons in the US. Few comprehensive large-scale and controlled studies examined the spectrum of autoimmune diseases occurring in psoriasis. Objective: To determine the autoimmune disorders associated with psoriasis in US adults and children, and the excess payer costs related to care for these autoimmune comorbidities. Methods: Data from the 2002-2012 National Inpatient Sample were analyzed, including a representative 20% sample of all US hospitalizations. Results: In adults, psoriasis was associated with ≥1 autoimmune disease (adjusted odds ratio [95% confidence interval]: 1.90 [1.86-1.94]), including 28 of 35 autoimmune disorders examined. Autoimmune disorders with the largest effect-size included including alopecia areata (8.61 [4.95-14.98]), vitiligo (5.88 [4.91-7.03]), erythema nodosum (3.59 [2.43-5.29]), ankylosing spondylitis (3.31 [2.86-3.83]), primary biliary cirrhosis (2.68 [2.21-3.25]), nonalcoholic steatohepatitis (2.71 [2.57-2.86]), and autoimmune hepatitis (2.88 [2.22-3.73]). In children, psoriasis was associated with increased odds of type 1 diabetes (1.68 [1.14-2.49]), rheumatoid arthritis (6.45 [2.65-15.69]), systemic lupus erythematosus (2.66 [1.18-5.99]), alopecia areata (49.11 [7.05-341.94]), vitiligo (23.11 [7.46-71.66]), autoimmune hemolytic anemia (7.23 [2.35-22.21]), and unspecified autoimmune disease [29.08 [8.23-102.83]). There were significant differences of geometric-mean cost of care among adult ($8168 [$8017-$8322] vs $7888 [$7780-$7997], P <.0001) and pediatric ($6842 [5808-8060] vs $5761 [5375-6176]), P =.0392) inpatients with psoriasis, with $76,120 and $49,991,534 in excess annual costs of inpatient care attributed to autoimmune disorders, respectively. Conclusions: Psoriasis was associated with hospitalization for multiple cutaneous and extracutaneous autoimmune disorders in adults and children, which contributed to substantial excess costs.