Epidemiology and comorbidities of psoriasis patients in a national database in Taiwan
Introduction
Psoriasis is a chronic inflammatory dermatosis and its prevalence varies in different countries [1], [2]. The prevalence is generally considered to be lower in Asians, but the exact prevalence is unknown. Historically, psoriasis has been considered a skin-specific disease, with the exception of association with arthritis (psoriatic arthritis). Recent findings in psoriasis research have shown that psoriasis is not just a skin disease but frequently associated with systemic comorbidities. However, the exact pathomechanism linking psoriasis and the comorbidities remains to be determined, and it is controversial whether psoriasis per se can be considered an independent risk factor for some of the comorbidities [3], [4]. Moreover, the comorbidities of psoriasis may be different in different populations due to genetic and non-genetic factors.
The present study aims to describe the epidemiology of psoriasis and the prevalence of comorbidities in patients with psoriasis in Taiwan. The population-based National Health Insurance (NHI) claims data in 2006 were used to identify psoriasis cases and their associated comorbidities, such that less commonly assessed disease association such as hepatitis, tuberculosis and autoimmune diseases were captured. Patients with either psoriasis or psoriatic arthritis, also referred to as ‘psoriatic diseases’, were included [5].
Section snippets
Setting
The NHI program in Taiwan is primarily funded by payroll tax premiums with additional subsidies from general government revenues. The system covers almost 99% of the total population of Taiwan with an extremely comprehensive benefits package (including preventive medicine, dental care services, outpatient and inpatient services, prescription drugs and Chinese herbal remedies). Healthcare providers are reimbursed by the NHI for the services based on a points system according to ‘fees for
Results
Table 1 shows demographic characteristics of the study cases and its comparison cohort by level of disease severity. The mean age of the study cases was 46.4 (standard deviation 18.6), and 62% were male. Fig. 1 depicts the prevalence of psoriasis by age and gender. Overall, PsO accounted for 2.35‰ of the total population. Male and advancing age were generally associated with a higher prevalence rate. Fig. 2 shows the prevalence of PsO by level of severity. Prevalence of sPsO and mPsO was 0.41‰
Discussion
In our study, 53,761 psoriasis cases were identified from 23 million Taiwanese population, giving an annual prevalence of 2.35‰. There were 33,024 males and 20,737 females, giving a 1.59:1 ratio. The result is very close to the previous report using a sample cohort of 997,771 NHI claims data from 2000–2006 in Taiwan, which gave the mean one-year prevalence of psoriasis at 1.90‰, and the male to female ratio of 1.24 [2].
The lower prevalence in the previous study may be due to sampling (i.e. less
Conclusions
Psoriasis was associated with a significantly increased risk of comorbidities, especially for those patients with moderate to severe disease. These health associations should be taken into consideration when evaluating the burdens of psoriasis and designing effective treatment plans.
Acknowledgements
The financial support provided by Janssen-Cilag is gratefully acknowledged; it should, however, be emphasized that the authors have retained total independence in the preparation of this manuscript.
References (53)
- et al.
Psoriasis may not be an independent risk factor for acute ischemic heart disease hospitalizations: results of a large population-based Dutch cohort
J Invest Dermatol
(2010) - et al.
Japanese Society for Psoriasis Research. A survey of psoriasis patients in Japan from 1982 to 2001
J Dermatol Sci
(2003) - et al.
Disease concomitance in psoriasis
J Am Acad Dermatol
(1995) - et al.
Prevalence of cardiovascular risk factors in patients with psoriasis
J Am Acad Dermatol
(2006) - et al.
The risk of lymphoma in patients with psoriasis
J Invest Dermatol
(2006) - et al.
Psoriasis and risk of incident cancer: an inception cohort study with a nested case–control analysis
J Invest Dermatol
(2009) - et al.
Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and co-morbid conditions
J Invest Dermatol
(2010) - et al.
Tunisian erythematosus pemphigus associated with psoriasis in two sisters
Ann Dermatol Venereol
(2006) - et al.
Development of pemphigus vulgaris in a patient with psoriasis treated with cyclosporine
J Am Acad Dermatol
(2010) - et al.
Pemphigus vulgaris after initiation of psoralen and UVA therapy for psoriasis
J Am Acad Dermatol
(1994)
Drug-induced systemic lupus erythematosus and TNF-alpha blockers
Lancet
Lack of association between NOD2 3020InsC frameshift mutation and psoriasis
J Invest Dermatol
Lesional Th17 cells in pemphigus vulgaris and pemphigus foliaceus
J Dermatol Sci
Potential role of interleukin-17 in the pathogenesis of bullous pemphigoid
Med Hypotheses
The prevalence of psoriasis in the world
J Eur Acad Dermatol Venereol
Epidemiological study of psoriasis in the national health insurance database in Taiwan
Acta Derm Venereol
Psoriasis is independently associated with psychiatric morbidity and adverse cardiovascular risk factors, but not with cardiovascular events in a population-based sample
J Eur Acad Dermatol Venereol
Psoriatic disease: from skin to bone
Nat Clin Pract Rheumatol
Using Taiwan's national health insurance research databases for pharmacoepidemiology research
J Food Drug Anal
Statistical yearbook: population by age, 2006
Utilization of outpatient care for psoriasis
J Am Acad Dermatol
An epidemiologic study of Taiwanese psoriatic patients in a single clinic
Dermatol Sinica
Study on psoriasis cases in East Pakistan
J Trop Med Hyg
Malaysian Psoriasis Registry: preliminary report of a pilot study using a newly revised registry form
Med J Malaysia
Natural history of psoriasis: a study from the Indian subcontinent
J Dermatol
Cited by (252)
Downregulation of Caveolae-Associated Proteins in Psoriasis: A Case Series Study
2024, JID Innovations2022 Taiwanese Dermatological Association (TDA), Taiwanese Association for Psoriasis and Skin Immunology (TAPSI), and Taiwan Society of cardiology (TSOC) joint consensus recommendations for the management of psoriatic disease with attention to cardiovascular comorbidities
2023, Journal of the Formosan Medical AssociationPsoriasis and hidradenitis suppurativa: A large-scale population-based study
2023, Journal of the American Academy of DermatologyComorbidities in Patients with Vitiligo: A Systematic Review and Meta-Analysis
2023, Journal of Investigative DermatologyEstradiol suppresses psoriatic inflammation in mice by regulating neutrophil and macrophage functions
2022, Journal of Allergy and Clinical Immunology