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The association between psoriasis, diabetes mellitus, and atherosclerosis in Israel: A case-control study

https://doi.org/10.1016/j.jaad.2006.09.017Get rights and content

Background

Previous reports demonstrated an association between psoriasis and other diseases including heart failure and diabetes mellitus.

Objectives

Our aim was to describe the association between psoriasis, diabetes mellitus, and atherosclerosis in Israel.

Methods

A cross-sectional study was performed utilizing the database of Maccabi Healthcare Services (MHS), a large health provider organization in Israel. Case patients were defined as subjects who were diagnosed with psoriasis. Patients with diabetes and atherosclerosis were identified by using the MHS diabetes and cardiovascular registries, respectively. The control group included MHS enrollees without psoriasis. The proportion of diabetes and atherosclerosis among case and control groups was compared. Chi-square tests were used to compare categorical parameters. Logistic regression models were used for multivariate analyses.

Results

The study included 46,095 patients with psoriasis (case patients) and 1,579,037 subjects without psoriasis (control patients). The age-adjusted proportion of diabetes was significantly higher in psoriasis patients as compared with the control group (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.1-1.48). The age-adjusted proportion of atherosclerosis was significantly higher in psoriasis patients as compared with the control group (OR 1.28, 95% CI 1.04-1.59). In patients with psoriasis, a multivariate logistic regression model demonstrated an association between diabetes and the multiple use of very potent topical steroids (P < .05) or use of systemic medication for psoriasis (methotrexate, cyclosporine or acitretin) (P < .001). A similar model demonstrated an association between atherosclerosis and the use of phototherapy (P < .001).

Limitations

Our study was based on a computerized database. The diagnosis of psoriasis was based on digitally transmitted data. Therefore overestimation (false-positive cases) and underestimation (false-negative cases) of psoriasis patients may exist, thereby being a source for information bias. A second limitation is selection bias that may occur due to the possibility that reporting of both psoriasis and associated illnesses is higher in individuals who are seeking medical care. A third limitation concerns the causal effect between occurrence of psoriasis and atherosclerosis or diabetes. The dataset of MHS records diagnoses only from 1997 and does not record the date of disease onset.

Conclusions

Our study supports previous reports for an association between psoriasis and atherosclerosis and psoriasis and diabetes. Further study is needed to support this observation.

Section snippets

Methods

The study was designed as a retrospective case-control study using data mining techniques utilizing the MHS database. MHS is the second largest organization for managed care in Israel. MHS covers a population of more than 1,600,000 enrollees. MHS has a comprehensive computerized database that has continuous real-time input from pharmaceutical, medical, and administrative computerized operating systems. Most psoriasis patients are treated by MHS dermatologists. Some are treated by primary

Results

The study included 46,095 patients with psoriasis and a control group of 1,579,037 MHS enrollees. The patients' characteristics appear in Table I. Age and gender distribution of patients with psoriasis is presented in Fig 1.

The Diabetes Registry includes 61,696 patients. The proportions of diabetes in patients with psoriasis and the control group are presented in Table II. The proportion of diabetes in the control group corresponds to the proportion of diabetes in Israel16 as well as to the

Discussion

In the current study we observed that psoriasis was associated with diabetes and atherosclerosis. The association was prominent in patients between 35 and 55 years of age and in women. Our study supports previous observations by Henseler and Christophers14 and other authors.3, 5, 6, 8

Previous studies have shown an increased risk of atherosclerosis in patients with systemic lupus erythematosus and rheumatoid arthritis.18, 19 Inflammation was shown to be a key factor in atherogenesis, providing a

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    Funding sources: None.

    Conflicts of interest: None identified.

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