Journal of Clinical Medicine · 9 authors, 4 centres
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This large population-based study in Spain found a psoriasis prevalence of 2.84% and that nearly three-quarters of patients have multimorbidity. The strongest associations were with tuberculosis, cystic fibrosis, and otitis externa, while common comorbidities included lipid disorders, hypertension, and obesity. These findings underscore the need for comprehensive comorbidity monitoring in psoriasis management.
**Background:** Psoriasis is a chronic inflammatory skin disease with a prevalence of about 2% globally, though it varies by population. It is associated with numerous comorbidities, including psoriatic arthritis, type 2 diabetes, metabolic syndrome, cardiovascular disease, and mental health conditions. Understanding the full comorbidity profile is essential for optimal patient care. This study aimed to determine psoriasis prevalence in a large Spanish cohort and exhaustively describe its associated comorbidities.
**Methods:** This retrospective observational study used the EpiChron Cohort, which includes electronic health records from approximately 98% of inhabitants of Aragon, Spain (reference population 1.3 million). All 31,178 patients with a psoriasis diagnosis in 2019 were included. Variables studied included sex, age, residence area, deprivation index, country of birth, and all chronic conditions and selected acute diseases. Diagnoses were coded using ICD-9-CM and grouped into 226 clinical categories using the Clinical Classifications Software (CCS); 153 were classified as chronic. Logistic regression models were used to calculate odds ratios (ORs) for each comorbidity based on psoriasis presence, adjusted for sex and age.
**Key Results:** The overall psoriasis prevalence was 2.84% (31,178 out of 1,098,383). Prevalence was significantly lower in women (2.43%) than men (3.31%) (OR 0.73, 95% CI 0.71–0.74). Spanish individuals had higher prevalence than other nationalities (ORs from 0.21 to 0.82). Rural residence showed slightly lower prevalence (OR 0.96, 95% CI 0.94–0.98). Approximately 73.76% of psoriasis patients had multimorbidity, with a mean of 3.75 (SD 2.97) chronic diseases. The most frequent chronic comorbidities were disorders of lipid metabolism (35.87%), hypertension (35.50%), and other nutritional-endocrine-metabolic disorders (21.79%). After adjustment, the conditions most strongly associated with psoriasis were tuberculosis (OR 2.36, 95% CI 1.24–4.49), cystic fibrosis (OR 2.15, 95% CI 1.25–3.69), and otitis externa (OR 1.65, 95% CI 1.44–1.88). Other significant associations included other liver diseases (OR 1.57, 95% CI 1.46–1.68), regional enteritis and ulcerative colitis (OR 1.50, 95% CI 1.32–1.71), rheumatoid arthritis and related disease (OR 1.42, 95% CI 1.28–1.57), obesity (OR 1.23, 95% CI 1.19–1.28), alcohol-related disorders (OR 1.26, 95% CI 1.16–1.37), anxiety disorders (OR 1.12, 95% CI 1.09–1.16), and depression (OR 1.10, 95% CI 1.06–1.13). No significant association was found with hypertension (OR 0.98, 95% CI 0.96–1.01) or neoplasms (OR 0.90, 95% CI 0.86–0.95).
**Clinical Implications:** This study confirms that psoriasis is a systemic disease with a high burden of multimorbidity, affecting nearly three-quarters of patients. The strong associations with infectious, metabolic, musculoskeletal, and psychiatric conditions highlight the need for comprehensive, multidisciplinary care. Clinicians should proactively screen for and manage comorbidities such as dyslipidemia, obesity, diabetes, liver disease, inflammatory bowel disease, and mental health disorders. The unexpected inverse or null associations with hypertension and neoplasms warrant further investigation. The findings support the importance of holistic patient management beyond skin-directed therapy.