Dataset Information

Alcohol-Related Mortality in Patients With Psoriasis: A Population-Based Cohort Study.

ABSTRACT: Importance:People diagnosed with psoriasis have an increased risk of premature mortality, but the underlying reasons for this mortality gap are unclear. Objective: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. Main Outcomes and Measures: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. Results: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%). Conclusions and Relevance: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.

SUBMITTER: Parisi R

PROVIDER: S-EPMC5817445 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Alcohol-Related Mortality in Patients With Psoriasis: A Population-Based Cohort Study.

Parisi Rosa R Webb Roger T RT Carr Matthew J MJ Moriarty Kieran J KJ Kleyn C Elise CE Griffiths Christopher E M CEM Ashcroft Darren M DM

JAMA dermatology 20171201 12

<h4>Importance</h4>People diagnosed with psoriasis have an increased risk of premature mortality, but the underlying reasons for this mortality gap are unclear.<h4>Objective</h4>To investigate whether patients with psoriasis have an elevated risk of alcohol-related mortality.<h4>Design, setting, and participants</h4>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 ...[more]

PMID: 28914955

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Project description:BackgroundSocial isolation and living alone are increasingly common in industrialised countries. However, few studies have investigated the potential public health implications of this trend. We estimated the relative risk of death from alcohol-related causes among individuals living alone and determined whether this risk changed after a large reduction in alcohol prices.Methods and findingsWe conducted a population-based natural experimental study of a change in the price of alcohol that occurred because of new laws enacted in Finland in January and March of 2004, utilising national registers. The data are based on an 11% sample of the Finnish population aged 15-79 y supplemented with an oversample of deaths. The oversample covered 80% of all deaths during the periods January 1, 2000-December 31, 2003 (the four years immediately before the price reduction of alcohol), and January 1, 2004-December 31, 2007 (the four years immediately after the price reduction). Alcohol-related mortality was defined using both underlying and contributory causes of death. During the 8-y follow-up about 18,200 persons died due to alcohol-related causes. Among married or cohabiting people the increase in alcohol-related mortality was small or non-existing between the periods 2000-2003 and 2004-2007, whereas for those living alone, this increase was substantial, especially in men and women aged 50-69 y. For liver disease in men, the most common fatal alcohol-related disease, the age-adjusted risk ratio associated with living alone was 3.7 (95% confidence interval 3.3, 4.1) before and 4.9 (95% CI 4.4, 5.4) after the price reduction (p<0.001 for difference in risk ratios). In women, the corresponding risk ratios were 1.7 (95% CI 1.4, 2.1) and 2.4 (95% CI 2.0, 2.9), respectively (p ? 0.01). Living alone was also associated with other mortality from alcohol-related diseases (range of risk ratios 2.3 to 8.0) as well as deaths from accidents and violence with alcohol as a contributing cause (risk ratios between 2.1 and 4.7), both before and after the price reduction.ConclusionsLiving alone is associated with a substantially increased risk of alcohol-related mortality, irrespective of gender, socioeconomic status, or the specific cause of death. The greater availability of alcohol in Finland after legislation-instituted price reductions in the first three months of 2004 increased in particular the relative excess in fatal liver disease among individuals living alone.

Project description:ObjectivesThe aim was to assess alcohol-related mortality of persons with mixed and uniform ethnic origins in two national contexts.SettingData were from the multigenerational population registers of the total population of Finland and Sweden observed from 1971 to 2017. Study persons were men and women of ethnic Finnish and Swedish background, born in their country of residence.ParticipantsPersons were born between 1953 and 1999. In Finland, ethnic origin was assessed through own, mother's and father's Finnish or Swedish ethnolinguistic affiliation. Data on Sweden included persons born in Sweden, with mother and father born in Sweden or Finland. A total of 2 997 867 and 4 148 794 persons were included in the Finnish and Swedish data, respectively. The total number of alcohol-related deaths by main cause was 13 204 and 3336. Cox regressions were used to examine associations.Outcome measuresFor the period 1971-2017, we studied alcohol as the main cause of death. For the period 1996-2017, we observed if alcohol was the main or contributing cause of death. Parallel analyses were performed for all-cause mortality.ResultsFor men in Finland, the hazard rate of alcohol-related mortality of Swedish speakers with uniform Swedish background was 0.44 (95% CI: 0.38 to 0.52) that of Finnish speakers with uniform Finnish background. The corresponding hazard rate for women was 0.40 (95% CI: 0.28 to 0.55). In Sweden, the hazard rate of men with both parents born in Sweden was 0.40 (95% CI: 0.32 to 0.49) that of men with both parents born in Finland. The corresponding hazard rate for women was 0.50 (95% CI: 0.31 to 0.79). In both countries, persons with mixed background had an alcohol-related mortality rate between that of persons with uniform Finnish and Swedish background.ConclusionThe consistent pattern across countries necessitates increased policy attention towards offspring disadvantaged via parental ethnicity to minimise harmful consequences of alcohol consumption across and within ethnic groups.

Dataset Information

Alcohol-Related Mortality in Patients With Psoriasis: A Population-Based Cohort Study.

Publications

Alcohol-Related Mortality in Patients With Psoriasis: A Population-Based Cohort Study.

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