Recent studies show that the incidence of psoriasis is decreasing, but older people in Taiwan are at increased risk of developing psoriasis and psoriatic arthritis.
Psoriasis and psoriatic arthritis Because (PsA) is associated with older people and early birth cohorts, older people may be at increased risk of developing these conditions, according to a recently published study. Clinical Medical Journal.
Most studies on psoriasis and PsA are from Western countries and include most of the effects of age, duration, and birth cohort on the prevalence or prevalence of psoriasis, which is less common in Asian countries. plug. Part of this reason is due to genetics. The authors state that the gene most strongly associated with susceptibility to the disease, the human leukocyte antigen (HLA) -Cw6 locus, is expressed at lower levels in the Taiwanese population compared to the white population.
However, the difference may also depend on lifestyle factors that may be more common among specific groups born at specific times, or on the development of health. To that end, researchers examined Taiwan’s psoriasis trends from 2002 to 2016 using an age-duration-cohort (APC) model to distinguish between the independent effects of these factors on temporal trends. I tried.
Using data from the National Health Insurance Research Database, they identified 112,865 psoriasis incidents with an average incident rate of 34.21 per 100,000. The incidence of psoriasis dropped significantly from 43.33 to 23.14 per 100,000 people between 2002 and 2016.
However, the incidence of PsA increased significantly from 3.57 per 100,000 to 5.22 over the same period, reaching a peak of 6.76 per 100,000 in 2014.
The incidence of psoriasis decreased, but the prevalence of psoriasis increased with an annual change of 6.8% (P <.001). The prevalence of PsA also increased with an annual change of 11% (P <.001).
Given that previous studies have shown that severe psoriasis is at increased risk of developing PsA, the authors associate an increased incidence of PsA with an increased prevalence of psoriasis. It suggests that. Despite the declining trend in the incidence of psoriasis, this may explain the increased incidence of PsA.
APC analysis showed that the net age effect on the incidence of psoriasis and PsA increased with increasing age. The oldest birth cohort had the highest incidence of psoriasis, 17 times higher than the youngest birth cohort.
The net period effect tended to decrease in psoriasis but increased in PsA. The incidence rate decreased by about 25% in psoriasis, but increased by 1.7-fold in PsA during the observation period.
Studies have shown that the net cohort effect on psoriasis and PsA incidence has continued to decline since 1937. The incidence of psoriasis and PsA decreased by 43.4% and 72.1%, respectively, from the earliest birth cohort to the most recent birth cohort, respectively.
The authors state that this may be due to the later cohort (that is, young individuals) being well educated about health issues and becoming more aware of a healthy lifestyle.
Overall, the results of the statistical analysis revealed a significant decrease in the incidence of psoriasis and a significant increase in the incidence of PsA. Incidences showed opposite trends, but incidences of both conditions remained high in the elderly population.
The authors note that an increase in prevalence of psoriasis and / or PsA may be associated with increased awareness of the disease, decreased mortality, or an actual increase in prevalence. Suggests.
In addition, they state that the decreasing and increasing trends in psoriasis incidence and prevalence, respectively, suggest a reduction in psoriasis-related mortality. They said a longitudinal study was needed to test this hypothesis.
Researchers hope that their findings will help better understand psoriasis and PsA, and help improve health care allocation and health policy. They recommend conducting a comprehensive project on health promotion and effective screening strategies, especially for middle-aged and older individuals. To address the risk of PsA and delayed diagnosis, they also encouraged cooperation between dermatologists and rheumatologists.
This study had some limitations. Because the APC model produces estimates, it was not possible to identify the causal relationship of the observed relationships.
In addition, including only patients who have been seen three times in a row in dermatology and rheumatology may have underestimated the incidence and prevalence of both psoriasis and PsA.
reference
Chen YT, Wu CY, Li YL, Chen LY, Chiou HY Temporal trends in psoriasis and PsA incidence in Taiwan from 2002 to 2016: age-duration-cohort analysis. J. Clin. Med. 2022; 11 (13): 3744. doi.org: 10.3390 / jcm11133744.
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