New Report Highlights Health Disparities in Psoriasis Care

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The National Psoriasis Foundation recently released its psoriasis health indicator report, a first-of-its-kind presentation on the health impacts of the disease all in one place. The report provides context on the status of psoriasis and its complications in the US, including current information and data on the disease, health outcomes, prevention of comorbidities associated with psoriasis, health disparities, and treatment and management of patients with psoriasis.

While no national goals exist to guide improvements in psoriatic disease care, the report does include data connecting psoriasis to existing national goals for related diseases and conditions. The organization stated public data on the health of patients with psoriasis is extremely limited, leading the report to turn to studies published in peer-reviewed journals that utilize publicly available national data. The majority of the data compiled for the study was collected from published studies using sources such as patient registries, surveys of patients and providers, systematic literature reviews and meta-analyses, and insurance claim databases.¹

Incidence and Prevalence

According to the report, it is now estimated that 3% of the US adult population 20 years and older (n = 7.5 million) are affected by psoriasis. Men and women face roughly the same prevalence (2.8% and 3.2%), and White populations have the highest prevalence of psoriasis (3.6%) followed by Asian populations (2.5%) and then Black populations (1.5%). The report found that roughly 1.9% of Hispanic people have psoriasis. Among adults, the organization stated that individuals between the ages of 20 to 29 have the lowest prevalence (1.6%) and individuals between the ages of 50 to 59 experience the highest prevalence (4.3%).² As for psoriatic arthritis, the report stated that 9% to 33% of patients with psoriasis develop psoriatic arthritis.³

Race and Ethnicity

The report found that racial and/or ethnic minoritized individuals are 112% more likely to live with undiagnosed psoriasis than White individuals. Compared to White individuals, researchers stated that individuals with skin of color wait 3 times longer to receive a diagnosis and are 3 times more likely to have a skin biopsy to confer their diagnosis.⁴

Burden of Disease

“Psoriasis is associated with significant burden of disease, including increased rates of mortality, decreased quality of life, stigmatization, and loss of work productivity,” the report stated. While comorbidities mediate the increased mortality risk of psoriasis, researchers found that psoriasis is independently associated with increased risk of mortality. Individuals with severe psoriasis (body surface area (BSA) > 10%) have an 80% increased risk of mortality independent of other risk factors such as a history of smoking, age, or comorbidities. Cardiovascular disease (15.5%) and chronic kidney diseases (11.7%) were found to have the largest mediating effect.⁵

Patients with psoriasis face a considerable burden on the quality of life, according to the report, which stated that 40.6% to 43.3% of patients reported that their psoriasis had a moderate to very large effect on their lives. Impact on quality of life was noted to increase depending on disease severity and location, with activity involving the scalp, face, hands, feet, or genitals being associated with increased impact.⁶ Among individuals with psoriasis, the organization found that 72.4% reported some activity impairment.⁷

The report found that social stigmas against individuals with psoriasis are notably widespread, with the general population often expressing discomfort in various social situations. People without psoriasis generally report higher levels of unease—such as avoiding dating, shaking hands, or inviting someone with psoriasis into their home—compared to the perceptions of those with the condition. They noted this discrepancy highlights a significant gap between the perceived and actual social barriers faced by people with psoriasis.

Comorbidities

Psoriasis is linked to several comorbid conditions, including psoriatic arthritis, cardiovascular disease, obesity, and diabetes/metabolic disorders. Psoriatic arthritis often suffers from delayed diagnosis due to the lack of a specific diagnostic test, leading to poor outcomes like functional impairment and disability.⁸ Risk factors for developing psoriatic arthritis include psoriasis severity, obesity, depression, and age, with incidence rates rising significantly with age.⁹ Cardiovascular disease is also a notable concern, as systemic inflammation associated with psoriasis contributes to an increased risk of heart attack, stroke, and cardiovascular mortality, with affected individuals experiencing notably higher risks compared to the general population.¹⁰ The report stated early detection and management of these comorbidities are crucial to mitigating long-term health impacts.

Areas for Future Work

This report offers the first comprehensive examination of the health status of individuals with psoriasis, revealing significant challenges and gaps in care. It underscores the impact of psoriasis on overall health and highlights disparities, particularly in the diagnosis and treatment of psoriasis among individualswith skin of color. To address these issues, the report emphasizes the need for improved cultural competence in healthcare, greater diversity in clinical trials, and better integration of knowledge about psoriasis and its comorbidities into clinical practice. It also stresses the importance of addressing the mental health impacts of psoriasis and conducting more research on dietary interventions. Additionally, the report points out the lack of comprehensive national data on psoriasis, which limits understanding and hampers efforts to improve care. Overall, it calls for enhanced awareness, improved care coordination, and further research to better support individuals with psoriasis.

References

1. Psoriasis health indicator report. National Psoriasis Foundation. Published January 2024. Accessed August 21, 2024. https://www.psoriasis.org/health-indicator-report/ 
2. Armstrong AW, Mehta MD, Schupp CW, et al. Psoriasis prevalence in adults in the United States. JAMA Dermatol. 2021;157(8):940-946. doi:10.1001/jamadermatol.2021.2007
3. Mease PJ, Gladman DD, Papp KA, et al. Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol. 2013;69(5):729-735. doi:10.1016/j.jaad.2013.07.023
4. Dickerson T, Pratt A, O'Quinn M, et al. Racial disparities in the diagnosis of psoriasis. Cutis. 2022;110(2 Suppl):26-28. doi:10.12788/cutis.0576
5. Semenov YR, Herbosa CM, Rogers AT, et al. Psoriasis and mortality in the United States: data from the national health and nutrition examination survey. J Am Acad Dermatol. 2021;85(2):396-403. doi:10.1016/j.jaad.2019.08.011
6. Merola JF, Ogdie A, Gottlieb AB, et al. Patient and physician perceptions of psoriatic disease in the United States: Results from the UPLIFT survey. Dermatol Ther (Heidelb). 2023;13(6):1329-1346. doi:10.1007/s13555-023-00929-9
7. Lewis-Beck C, Abouzaid S, Xie L, et al. Analysis of the relationship between psoriasis symptom severity and quality of life, work productivity, and activity impairment among patients with moderate-to-severe psoriasis using structural equation modeling. Patient Prefer Adherence.2013;7:199-205. doi:10.2147/PPA.S39887
8. Mease PJ, Gladman DD, Helliwell P, et al. Comparative performance of psoriatic arthritis screening tools in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol. 2014;71(4):649-655. doi:10.1016/j.jaad.2014.05.010
9. Ogdie A, Shin DB, Love TJ, et al. Body surface area affected by psoriasis and the risk for psoriatic arthritis: a prospective population-based cohort study. Rheumatology (Oxford). 2022;61(5):1877-1884. doi:10.1093/rheumatology/keab622
10. Liu L, Cui S, Liu M, et al. Psoriasis increased the risk of adverse cardiovascular outcomes: A new systematic review and meta-analysis of cohort study [published correction appears in Front Cardiovasc Med. 2022 May 13;9:929149. doi: 10.3389/fcvm.2022.929149]. Front Cardiovasc Med. 2022;9:829709. Published 2022 Mar 25. doi:10.3389/fcvm.2022.829709