P107 Life expectancy, all-cause mortality and cause-specific mortality in psoriasis and generalized pustular psoriasis: a population-based cohort study in England

Abstract

Psoriasis and generalized pustular psoriasis (GPP) are associated with significant morbidity. Understanding mortality patterns, and underlying causes of death, is paramount for enhancing management and outcomes in these patients. We aimed to investigate excess mortality and cause-specific deaths in patients with psoriasis and GPP compared with the general population. This was a retrospective cohort study using data from the Clinical Practice Research Datalink, an anonymized primary care electronic health records database from general practices, linked with hospital and mortality records. Patients with a first diagnosis of psoriasis (n = 343 583) or GPP (n = 834) between 1 January 1998 and 31 December 2022 were matched with comparators without these conditions (1 : 5 in the psoriasis cohort, 1 : 10 in the GPP cohort). Flexible parametric survival models were used to estimate adjusted hazard ratios (aHRs) for all-cause and cause-specific mortality. Abridged life tables were generated to estimate life expectancy among cases and comparators. Crude mortality rates were 13.7 per 1000 person-years [95% confidence interval (CI) 13.5–13.8] in patients with psoriasis and 56.4 per 1000 person-years (95% CI 50.0–63.6) in patients with GPP. Compared with matched comparators, psoriasis and GPP were associated with increased all-cause mortality: aHR 1.18 (95% CI 1.16–1.19) and aHR 3.29 (95% CI 2.81–3.84), respectively. The main underlying causes of death in patients with psoriasis were respiratory diseases, circulatory diseases, neoplasms, digestive diseases, sepsis and urinary diseases. In GPP, the main causes were respiratory diseases, neoplasms, circulatory diseases, sepsis and digestive diseases. Diagnoses of psoriasis and GPP at any age were associated with poorer life expectancy compared with the general population; however, years of life lost declined with older age. At age 40 years, people diagnosed with psoriasis or GPP were predicted to have on average 2 years and 19 years, respectively, of potential life lost. Excess mortality and shortened life expectancy remain in patients with psoriasis and GPP. Our findings warrant further attention to the prevention and management of comorbidities.