All-Cause Mortality is Higher in Generalized Pustular Psoriasis (GPP) than Plaque Psoriasis and the General Population: A US-Based Claims Analysis

Abstract

Background: Limited literature exists on the mortality burden of generalized pustular psoriasis (GPP) in the US. Objective: To compare all-cause mortality among patients with GPP with matched populations of patients with plaque psoriasis (PsO) and the general population in the US. Methods: An observational study was conducted using US claims data collected between January 1, 2016 and December 31, 2019. All-cause mortality was evaluated at 365 days post-index and at maximum follow-up in the following cohorts: GPP-only, Plaque-PsO-only, GPP + PsO, All-GPP, and general population. Propensity score matching was used to balance covariates between cohorts. The index date was the first medical claim for GPP (ICD-10 code L40.1) or PsO (L40.0), and a randomly selected date per year for individuals in the general population cohort. Results: 1246 patients were included in GPP-only, 1384 in GPP + PsO, 2630 in All-GPP and 127,540 in plaque-PsO-only. 19,641,441 individuals were included in general population. The maximum follow-up ranged from 36.14 to 41.28 months (3.01-3.44 years). At 365-day follow-up, mortality risk was significantly higher in the All-GPP vs the general population (hazard ratio [HR] 4.93, 95% confidence interval [CI] 2.24-10.88) and plaque-PsO-only (HR 2.31, 95% CI 1.32-4.04) cohorts. At maximum follow-up, the mortality risk for the All-GPP cohort was four times higher than the general population (HR 3.98, 95% CI 2.92-5.43) and 1.5 times higher than the plaque-PsO-only (HR 1.49, 95% CI 1.20-1.85) cohorts. Conclusion: Patients with GPP exhibited an elevated mortality risk in comparison to the matched plaque-PsO and general population cohorts.