Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, England.
Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, England.
JAMA Dermatol. 2017 Dec 1;153(12):1256-1262. doi: 10.1001/jamadermatol.2017.3225.
People diagnosed with psoriasis have an increased risk of premature mortality, but the underlying reasons for this mortality gap are unclear.
To investigate whether patients with psoriasis have an elevated risk of alcohol-related mortality.
DESIGN, SETTING, AND PARTICIPANTS: An incident cohort of patients with psoriasis aged 18 years and older was delineated for 1998 through 2014 using the Clinical Practice Research Datalink (CPRD) and linked to Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality records. Patients with psoriasis were matched with up to 20 comparison patients without psoriasis on age, sex, and general practice.
Alcohol-related deaths were ascertained via the Office for National Statistics mortality records. A stratified Cox proportional hazard model was used to estimate the cause-specific hazard ratio for alcohol-related death, with adjustment for socioeconomic status.
The cohort included 55 537 with psoriasis and 854 314 patients without psoriasis. Median (interquartile) age at index date was 47 (27) years; 408 230 of total patients (44.9%) were men. During a median (IQR) of 4.4 (6.2) years of follow-up, the alcohol-related mortality rate was 4.8 per 10 000 person-years (95% CI, 4.1-5.6; n = 152) for the psoriasis cohort, vs 2.5 per 10 000 (95% CI, 2.4- 2.7; n = 1118) for the comparison cohort. The hazard ratio for alcohol-related death in patients with psoriasis was 1.58 (95% CI, 1.31-1.91), and 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 due to alcohol (7.9%).
People with psoriasis have approximately a 60% greater risk of dying due to alcohol-related causes compared with peers of the same age and sex in the general population. This appears to be a key contributor to the premature mortality gap. These findings call for routine screening, identification and treatment, using the Alcohol Use Disorders Identification Test (AUDIT-C) in both primary and secondary care to detect alcohol consumption and misuse among people diagnosed with psoriasis.
被诊断患有银屑病的人群有过早死亡的风险增加，但造成这种死亡率差距的根本原因尚不清楚。
研究银屑病患者是否有更高的酒精相关死亡率风险。
设计、环境和参与者：通过临床实践研究数据库（CPRD）在 1998 年至 2014 年间确定了年龄在 18 岁及以上的银屑病患者的发病队列，并与医院病例统计数据（HES）和国家统计局（ONS）死亡记录相链接。将银屑病患者与年龄、性别和全科医生相匹配的多达 20 名无银屑病的对照患者进行匹配。
通过国家统计局死亡记录确定与酒精相关的死亡。使用分层 Cox 比例风险模型来估计酒精相关死亡的特定原因风险比，并对社会经济地位进行调整。
该队列包括 55537 名银屑病患者和 854314 名无银屑病患者。指数日期的中位（四分位距）年龄为 47（27）岁；在总患者中，有 408230 名（44.9%）为男性。在中位（四分位距）4.4（6.2）年的随访期间，银屑病队列的酒精相关死亡率为每 10000 人年 4.8 例（95%CI，4.1-5.6；n=152），而对照组为每 10000 人年 2.5 例（95%CI，2.4-2.7；n=1118）。银屑病患者的酒精相关死亡风险比为 1.58（95%CI，1.31-1.91），酒精相关死亡的主要原因是酒精性肝病（65.1%）、肝脏纤维化和肝硬化（23.7%）以及酒精所致的精神和行为障碍（7.9%）。
与同年龄和同性别的一般人群相比，患有银屑病的人群因酒精相关原因导致死亡的风险增加约 60%。这似乎是导致过早死亡差距的一个关键因素。这些发现呼吁在初级和二级保健中使用酒精使用障碍识别测试（AUDIT-C）进行常规筛查、识别和治疗，以发现和治疗被诊断为银屑病的人群中的酒精消费和滥用。
