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Multimorbidity and mortality risk in hospitalized adults with chronic inflammatory skin disease in the United States

Abstract

Chronic inflammatory skin diseases (CISD) represent a significant burden of skin disease in the United States, and a growing number of studies demonstrate that CISD are associated with multiple comorbidities. However, few studies examined multimorbidity in adults with CISD. We sought to determine whether hospitalized US adults with chronic inflammatory skin disorders have increased multi-morbidity and mortality risk. Data from the 2002–2012 Nationwide Inpatient Sample were analyzed, including a representative 20% sample of US hospitalizations. Charlson comorbidity index (CCI) and mean estimated 10-year survival were calculated. Multivariable linear regression models were constructed with CCI score and mean estimated 10-year survival as the dependent variables and chronic inflammatory skin diagnosis, age and sex as the independent variables. CCI scores were significantly higher in bullous pemphigoid (P = 0.0005) and dermatomyositis (P < 0.0001), lower in hidradenitis suppurativa (P < 0.0001), pemphigus (P < 0.0001), rosacea (P < 0.0001), and not significantly different in atopic dermatitis, alopecia areata, and lichen planus compared to psoriasis. Conversely, the mean estimated 10-year survival was higher in pemphigus (P = 0.0451), lichen planus (P = 0.0352), rosacea (P < 0.0001), lower in bullous pemphigoid and dermatomyositis (P < 0.0001), and similar in atopic dermatitis, alopecia areata, and hidradenitis suppurativa compared to psoriasis. Each CISD had a distinct profile of comorbidities when compared to psoriasis. Hospitalized adults with multiple CISD have increased multimorbidity and decreased 10-year survival. Further studies are needed to develop multidisciplinary strategies aimed at preventing and treating multimorbidity, especially modifiable cardiovascular factors in adults with CISD.

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Data integrity statement

JI Silverberg had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. Study concept and design: JI Silverberg. Acquisition of Data: JI Silverberg, S Narla. Analysis and interpretation of data: S Narla, JI Silverberg, Drafting of the manuscript: S Narla, JI Silverberg. Critical revision of the manuscript for important intellectual content: S Narla, JI Silverberg. Statistical analysis: JI Silverberg, S Narla. Obtained funding: JI Silverberg. Administrative technical or material support: None. Study supervision: None. Financial disclosures: None. Design and conduct of the study? No. Collection, management, analysis and interpretation of data? No. Preparation, review, or approval of the manuscript? No. Decision to submit the manuscript for publication? No.

Abbreviations

ICD-9-CM:

International Classification of Disease 9th edition Clinical Modification

AD:

Atopic dermatitis

COPD:

Chronic obstructive pulmonary disease

CTD:

Connective tissue disease

AIDS:

Acquired immunodeficiency syndrome

MI:

Myocardial infarction

CKD:

Chronic kidney disease

CVA:

Cerebrovascular accident

TIA:

Transient ischemic attack

CHF:

Congestive heart failure

PUD:

Peptic ulcer disease

DM:

Diabetes mellitus

BP:

Bullous pemphigoid

HS:

Hidradenitis suppurativa

AA:

Alopecia areata

LP:

Lichen planus

NIS:

Nationwide inpatient sample

CI:

Confidence interval

CCI:

Charlson Comorbidity Index

HCUP:

Healthcare cost and utilization project

AHRQ:

Agency for healthcare research and quality

CISD:

Chronic inflammatory skin disease

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Funding

This publication was made possible with support from the Agency for Healthcare Research and Quality, grant number K12 HS023011, the Dermatology Foundation.

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Correspondence to Jonathan I. Silverberg.

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The authors declare that they have no competing interest.

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Narla, S., Silverberg, J.I. Multimorbidity and mortality risk in hospitalized adults with chronic inflammatory skin disease in the United States. Arch Dermatol Res (2020). https://doi.org/10.1007/s00403-020-02043-8

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Keywords

  • Psoriasis
  • Bullous pemphigoid
  • Pemphigus
  • Atopic dermatitis
  • Hidradenitis suppurativa
  • Dermatomyositis
  • Rosacea
  • Lichen planus
  • Alopecia areata
  • Chronic inflammatory skin disease
  • Comorbidity
  • Multimorbidity