Serious infection and hospitalization in patients with psoriasis

Serious infection and hospitalization in patients with psoriasis


Hello, my name is Kenneth Gordon. I’m a dermatologist at Northwestern and I’ll be discussing two papers that were recently published in the Journal of the American Academy
of Dermatology concerning psoriasis patients and hospitalization. When we think about the overall health of
psoriasis patients, we oftentimes think about outpatient care, the severity of disease,
and even comorbid disease like cardiovascular disease, renal disease, or depression. We rarely start thinking about the impact
of this disease on things like hospitalization and infection risk in hospitalization. Why that’s important is because these patients
do get hospitalized and if there’s a significant difference in patients who have significant
disease, then we might have to think about treating patients a little more aggressively
for their psoriasis. Moreover, understanding the populations who
might have issues associated with hospitalization in psoriasis is, I think, critical because
it really looks into the impact of access to care and how patients are cared for. You’re looking at whether this has greater
implication for their health. These 2 papers were papers that drive data
from the National Inpatient Survey. This is a survey of over 87 million hospitalizations
and they looked at both psoriasis primary diagnosis—that is, the primary reason for
admission was psoriasis—and where psoriasis was listed as a secondary diagnosis. Most importantly, in looking at these data
that were published in these papers, the thing that comes to mind is the rate of hospitalization
in patients and the demographics of those hospitalizations. As one would expect, patients who are older
tend to get hospitalized more frequently, but it’s in evaluation of the other demographic
characteristics that, I think, something really important is demonstrated. Patients from what we normally consider to
be underserved minority groups—patients who are Black or Hispanic—tend to have a
higher rate of hospitalization for psoriasis than patients who are white, and that is despite evidence that psoriasis is more common in white populations. Additionally, patients who have lower incomes
and have insurance that is not third-party, commercial insurance—but things like Medicaid
or non-insured or have Medicare—also tend to be hospitalized more frequently for psoriasis. While there are multiple explanations that
this could come from, I think it’s pretty suggestive that patients who have less access
to dermatologic care and high-level medications for psoriasis are more likely to be hospitalized
for psoriasis. Moreover, there is a cost to that, and the
hospitalization costs are not only high for the initial hospitalization for psoriasis,
but patients with psoriasis who are hospitalized tend to have longer hospitalizations than
patients without psoriasis. All this suggests that the cost of hospitalization,
potentially made worse by patients who do not have proper access to care, actually adds to our overall health care costs by quite
significant amounts. Then another paper looks at the potential
for infection in patients who are hospitalized with psoriasis. And what this paper suggests (to summarize
quite quickly) is that patients with psoriasis who are hospitalized tend to have a higher
rate of severe infections than do patients without psoriasis. Interestingly, one of the infections that
stands out in this study is cellulitis, a disease, infection of the skin, but even other infections are also increased in patients with psoriases When taken as a group, I think these patients
really demonstrate the severity of the impact of psoriasis on the overall health of patients,
is linked to hospitalization and severe infection, and really makes us think about how we can
distribute our therapy and medication to cover all groups of psoriasis to improve the health
of the general population.

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