Psoriasis One of the Most Common Immune-Mediated Diseases Affecting US Adults

Psoriasis remains one of the most common immune-mediated diseases affecting US adults, as revealed by a study published in JAMA Dermatology.

The population-based, cross-sectional study sought to add to findings published earlier this year, which found the prevalence of psoriasis in adults to be 2.8%. The authors of the current study used the same nationally representative dataset— the National Health and Nutrition Examination Survey (NHANES)—and combined survey cycles as well as evaluated the change in psoriasis prevalence over time, by comparing data back to NHANES data published in 2003-2004.

The population in the 2 NHANES cycles (2011-2012 and 2013-2014) was oversampled for Black, Hispanic, and low-income White participants to ensure that rates of disease burden are accounted for in these populations. Participants who completed the health survey were followed up with an in-person medical exam.

In the combined dataset, 12,625 individuals provided a yes or no answer when asked if they had ever been told by a health care provider that they had psoriasis; of those, 329 people answered the question about psoriasis severity.

To evaluate trends in psoriasis prevalence over time, the authors compared the 2011-2014 data with NHANES surveys conducted in 2009-2010 and 2003-2004 among adults aged 20 to 59.

Findings showed:

• Psoriasis prevalence among US adults was 3.0% (95% CI, 2.6%-3.4%), which translates to 7.55 million people.
• Psoriasis prevalence was 3.2% (95% CI, 2.6%-3.8%) in women and 2.8% (95% CI, 2.4%-3.3%) in men.
• Psoriasis prevalence was highest in White individuals at 3.6% (95% CI, 2.9%-4.2%), followed by other racial/ethnic groups (non-Hispanic, including multiracial) at 3.1% (95% CI 0.5%-5.1%), Asian individuals at 2.5% (95% CI, 1.6%-3.3%), Hispanic individuals (including Mexican American and other Hispanic individuals) at 1.9% (95% CI, 1.3%-2.5%), and Black individuals at 1.5% (95% CI, 1.0%-2.0%).
• Older age was associated with psoriasis (OR, 1.03; 95% CI, 1.01-1.04), as psoriasis prevalence was 1.6% among people aged 20 to 29 years, and 4.3% among those aged 50 to 59 years.

The prevalence of psoriasis among US adults was not statistically different from 2003, indicating that psoriasis remains one of the most common immune-mediated diseases affecting adults in the United States. Marital status, education, income, or medical insurance did not affect the prevalence of psoriasis among adults.

Determining the prevalence of psoriasis is critical because the data informs clinicians and patients on disease epidemiology and at-risk populations, shapes health care policies regarding the allocation of health care resources, and establishes baseline population estimates for subsequent studies evaluating subpopulations, the authors noted. Further, it is critical to educate primary care clinicians about the various clinical presentations of the disease, especially the presentation in people of color, because they will continue to be among the first to encounter patients with psoriasis.

The American Academy of Dermatology and National Psoriasis Foundation recommends that educational efforts regarding psoriasis should also include screening, early recognition, and treatment of psoriatic arthritis as well as cardiometabolic, hepatic, and mental health comorbidities, since 33% of patients with psoriasis develop psoriatic arthritis. Psoriasis and its associated comorbidities can lead to a decrease in quality of life and lead to substantial societal costs.

Reference

Armstrong AW, Mehta MD, Schupp CW, et al. Psoriasis prevalence in adults in the United States. JAMA Dermatol. Published online June 30, 2021. doi:10.1001/jamadermatol.2021.2007