SYSTEMATIC REVIEW article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1610499
All-Cause and Cause-Specific Mortality in Psoriasis Patients: A Systematic Review and Meta-Analysis
Provisionally accepted
- 1Beijing University of Chinese Medicine, Beijing, China
- 2Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, Beijing Municipality, China
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Objective: This meta-analysis aims to The objective of this meta-analysis is to assess the all-cause and cause-specific mortality in patients with psoriasis.In accordance with PRISMA guidelines, a systematic search of PubMed, EMBASE, and the Cochrane Library (from inception to March 2025) was conducted for cohort studies comparing mortality risks in psoriasis patients versus controls.Eligible studies comprised English-language cohort studies comparing mortality risk (HR/OR/RR) in adults with psoriasis versus healthy/non-psoriasis controls.Two reviewers independently screened studies, extracted data, and assessed study quality using the Newcastle-Ottawa Scale. Hazard ratios (HRs) were synthesized using random-effects models in Stata 14.0. Sensitivity analyses, subgroup analyses, and assessments of publication bias (via funnel plots and Egger's test) were also performed.: A total of 20 studies involving 8825989 participants were included. Psoriasis patients demonstrated significantly increased risks of all-cause mortality [HR=1.19, 95% CI (1.11-1.28), P=0.000], cardiovascular mortality [HR = 1.32, 95% CI (1.11-1.58), P = 0.002], infection-related mortality [HR=1.24, 95% CI (1.13-1.36), P=0.000], and suicide mortality [HR=1.50, 95% CI (1.03-2.19), P=0.034]. The risk of mortality due to neoplasms was marginally elevated but not statistically significant [HR=1.05, 95% CI (0.98-1.12), P=0.151]. No significant associations were found for neurological disease mortality [HR=0.96, 95%CI (0.83-1.11), P=0.976] or accident-related mortality [HR=0.91, 95% CI (0.81-1.02), P=0.629]. Sensitivity analysis supports the findings. Subgroup analyses revealed higher all-cause mortality risks in Europe (HR=1.11) and Asia (HR=1.23), as well as an increased risk with greater disease severity (moderate-to-severe: HR=1.44; severe: HR=1.54). No publication bias was detected. Conclusion: Psoriasis is associated with an increased risk of all-cause, cardiovascular, infection-related, and suicide mortality, highlighting the need for enhanced monitoring and targeted interventions to prevent adverse outcomes particularly for individuals with severe psoriasis.
Keywords: Psoriasis, Mortality, Cardiovascular, Infection, Suicide, Meta-analysis, Hazard ratio HR, hazard ratio, OR, odds ratio, RR, relative risk, CI, confidence intervals, MeSH, medical subject headings, NOS, Newcastle-Ottawa scale, PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PROSPERO, international prospective register of systematic reviews
Received: 12 Apr 2025; Accepted: 04 Jul 2025.
Copyright: © 2025 Yang, Zhang, Huang, Zhao, Yang, Wang and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Guomei Xu, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, 100029, Beijing Municipality, China
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