Study Highlights Risk, Prevalence of COPD Among Individuals with Psoriasis

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A new analysis of key findings on prevalence of chronic obstructive pulmonary disease (COPD) among patients with psoriasis identified a possible link between pulmonary disease and psoriasis, found that those with psoriasis have increased COPD prevalence and incidence,and that psoriasis is not shown to be an independent COPD risk factor.¹

These findings and others represented the conclusion of new research conducted to improve understanding of the connection between COPD and psoriasis. These findings may, in turn, help to enhance methods of condition management.

This analysis was led in part by Lily Guo, BS, of Duke University’s School of Medicine in Durham, North Carolina. Guo and colleagues noted that COPD is known to lead to diffuse pulmonary inflammation as well as potentially high rates of mortality.

“Therefore, it is essential to understand whether psoriasis patients are at increased risk of developing COPD, which may cause worse health outcomes,” Guo and colleagues wrote. “In this study, we aimed to determine (1) the prevalence and (2) incidence and risk of COPD among U.S. patients with psoriasis compared to those without psoriasis.”²

Background and Design

The investigators first goal in their research was to determine the rate of prevalence of COPD among individuals with diagnoses of psoriasis. With this aim in mind, the team implemented data which had been drawn from the National Health and Nutrition Examination Surveys (NHANES).

NHANES is a survey which is biennially released and nationally representative, employing a stratified, multistage probability cluster sampling. The survey is designed to help assess the health of the population within the US.

Individuals who were 20 years of age or older were enrolled in the NHANES study population. These participants would have to receive confirmation of whether or not a clinical diagnosis of psoriasis or emphysema, COPD, or chronic bronchitis had been provided to them.

The investigators of this analysis looked at psoriasis data from the 2003-2006 and 2009-2014 cycles at NHANES. They also combined National Center of Health Statistics information from the cycles of 2011-2012 and 2013-2014, with the purpose being to enhance their study’s statistical reliability and the stability of their prior determinations.

The research team looked into many different covariates from NHANES, some of which included sex, age, or race. Participants were also placed into unique racial groups: non-Hispanic Black, non-Hispanic White, Hispanic, and those labeled as Other.

The investigators also classified subjects’ levels of Income based on family poverty income ratio, with categories being lower (<1.3), medium (1.31-3.5), and higher (>3.5). They also assessed elements such as marital and education status.

The research team’s secondary goal was evaluating both the incidence and risk of COPD in those with reported psoriasis. Using Optum Clinformatics Data Mart (CDM), a de-identified administrative health claims database regarding US commercial insurance and Medicare Advantage plan owners, the team assessed patients aged 18 years or older.

These subjects could either have or not have a psoriasis diagnosis. Covariates such as sex, age, and race, in addition to clinical covariates defined by diagnostic and pharmacy codes, were looked into by the research team. They also calculated subjects’ incidence of COPD per 1000 person-years, using 95% confidence intervals (CIs).

Those with psoriasis would have an index date which was the earliest possible diagnosis date. Those who did not have psoriasis were matched by sex and by age, with the research team including them provided they had any visit date which would match patients’ index dates.

Findings

Overall, the investigators determined that prevalence of COPD had been shown to be higher among those that did have psoriasis, at a rate of 9.64%. This was compared to the 6.94% rate among subjects that did not report having psoriasis.

In a similar vein, the research team reported that the COPD rate of incidence had been 10.74 per 1,000 person-years among those who were shown to have psoriasis. This was compared to the rate of 6.36 per 1,000 person-years among subjects without COPD.

Despite these conclusions, the investigators' multivariable Cox regression analysis suggested that there was not a substantial link between development of COPD and psoriasis. Specifically, there was a hazard ratio noted by the team of 0.99 and a P-value of 0.271.

“Overall, we found that the prevalence and incidence of COPD are higher in psoriasis patients compared to the psoriasis-free population,” the investigators wrote. “However, psoriasis was not found to be an independent risk factor for COPD development.”

References

1. ^{Guo L, Bilimoria SN, Kikuchi R, Hao A, Tolson H, Yamamoto RK,
   Sadrolashrafi K, Yee D, Armstrong AW, Prevalence, Incidence, and Risk of Chronic Obstructive Pulmonary Disease Among Psoriasis Patients, Respiratory Medicine, https://doi.org/10.1016/
   j.rmed.2024.107729.}
2. ^{Christenson SA, Smith BM, Bafadhel M, Putcha N. Chronic obstructive pulmonary disease. Lancet. 2022 Jun 11; 399: 2227-2242.}