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• W2897300804 abstract "Psoriasis is a chronic inflammatory skin disease affecting about 3% of the population (Rachakonda et al., 2014Rachakonda T.D. Schupp C.W. Armstrong A.W. Psoriasis prevalence among adults in the United States.J Am Acad Dermatol. 2014; 70: 512-516Abstract Full Text Full Text PDF PubMed Scopus (577) Google Scholar). Over the past decade, more evidence has been published suggesting that psoriasis is not just a disease of the skin, but a disease of systemic inflammation, predisposing patients to other medical comorbidities. Previous large, population-based studies have found that patients with psoriasis have higher rates of serious infections requiring hospitalization compared to adults without psoriasis, with lower respiratory tract infections, including pneumonia, being most common (Kao et al., 2014Kao L.T. Lee C.Z. Liu S.P. Tsai M.C. Lin H.C. Psoriasis and the risk of pneumonia: a population-based study.PLoS One. 2014; 9: e116077Crossref PubMed Scopus (31) Google Scholar, Takeshita et al., 2018Takeshita J. Shin D.B. Ogdie A. Gelfand J.M. Risk of serious infection, opportunistic infection and herpes zoster among patients with psoriasis in the United Kingdom.J Invest Dermatol. 2018; 138: 1726-1735Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar, Wakkee et al., 2011Wakkee M. de Vries E. van den Haak P. Nijsten T. Increased risk of infectious disease requiring hospitalization among patients with psoriasis: a population-based cohort.J Am Acad Dermatol. 2011; 65: 1135-1144Abstract Full Text Full Text PDF PubMed Scopus (92) Google Scholar). Some respiratory infections are preventable through vaccination, but little is known about vaccination rates in psoriatic patients in the United States. Therefore, the objective of this study was to measure the rate of seasonal influenza vaccination in psoriasis patients in the United States and compare it to the rate of influenza vaccination in patients with other chronic diseases—rheumatoid arthritis and hypertension. Additionally, in psoriasis patients only, we sought to examine patient factors associated with receipt of a vaccination. We performed a cohort study using US-based administrative and commercial claims data from OptumInsight Clinformatics Data Mart (Optum, Eden Prairie, MN), including all adults (≥18 years of age) with a diagnosis of psoriasis, rheumatoid arthritis, or chronic hypertension requiring oral antihypertensive therapy and continuous enrollment during the 2010–2011 influenza season and 24 months prior (September 2008–March 2011). Because this was an analysis of de-identified data, the study was granted exempt status by the Institutional Review Board at the University of Pennsylvania. The primary outcome was an inpatient, outpatient, or pharmacy claim for an influenza vaccine during the 2010–2011 flu season (September 2010–March 2011). This flu season was selected because it was considered “typical,” by the Centers for Disease Control and Prevention, 2011Centers for Disease Control and Prevention. Final state-level influenza vaccination coverage estimates for the 2010–11 season—United States, National Immunication Survey and Behavorial Risk Factor Surveillance System, August 2010 through May 2011. https://www.cdc.gov/flu/fluvaxview/coverage_1011estimates.htm. Accessed April 17, 2016.Google Scholar. Measured covariates were age, sex, region of residency, and a history of any of the following medical comorbidities considered to confer higher risk for developing complications of influenza: asthma, congestive heart failure, chronic kidney disease, chronic liver disease, chronic obstructive pulmonary disease, HIV, smoking, history of solid organ transplantation, and history of malignancy. A previously validated algorithm designed to identify smoking history in medical claims data was used (Chen et al., 2013Chen L.H. Quinn V. Xu L. Gould M.K. Jacobsen S.J. Koebnick C. et al.The accuracy and trends of smoking history documentation in electronic medical records in a large managed care organization.Subst Use Misuse. 2013; 48: 731-742Crossref PubMed Scopus (16) Google Scholar). For patients with psoriasis and rheumatoid arthritis, information about treatments (including phototherapy) in the 3 months prior to the start of flu season (June 1, 2010–August 31, 2010) was also collected. Logistic regression was used to estimate the odds of vaccination in patients with chronic hypertension and rheumatoid arthritis compared to those with psoriasis, controlling for age, sex, and treatment (rheumatoid arthritis only). Finally, in psoriasis patients only, patient factors associated with receipt of a vaccine were identified using multivariable logistic regression. There were 17,078 patients with psoriasis, 21,832 with rheumatoid arthritis, and 496,972 with chronic hypertension requiring oral therapy (Table 1). Patients with psoriasis were younger than those with rheumatoid arthritis and chronic hypertension. As expected, 73% of patients with rheumatoid arthritis were female compared to 49.8% and 50.6% of patients with psoriasis and chronic hypertension, respectively. A history of psoriatic arthritis was present in 11% of psoriasis patients, and the prevalence of comorbidities was similar to what has been reported in the literature previously (Shah et al., 2017Shah K. Mellars L. Changolkar A. Feldman S.R. Real-world burden of comorbidities in US patients with psoriasis.J Am Acad Dermatol. 2017; 77: 287-292 e4Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar).Table 1Characteristics of the study population and mutually adjusted odds ratios for the association of receipt of an influenza vaccination in patients with psoriasisCharacteristicsChronic HTN1Value in this column are n (%), except for age, which is mean (standard deviation). (n = 496,972)RA1Value in this column are n (%), except for age, which is mean (standard deviation). (n = 21,832)Psoriasis1Value in this column are n (%), except for age, which is mean (standard deviation). (n = 17,078)Psoriasis Patients Only, OR (95% CI)Female251,059 (50.6)16,053 (73.6)8,500 (49.8)1.29 (1.20–1.38)Age, y60.8 (13.2)58.6 (14.3)52.7 (15.0)1.03 (1.02–1.03)History of smoking46,820 (9.4)2136 (9.8)1,675 (9.8)1.10 (0.98–1.24)Treatment with systemic agentNA9,618 (44.0)2,684 (15.7)1.03 (0.92–1.14)Medical comorbidities Asthma46,071 (9.3)2,950 (13.5)1,598 (9.4)1.58 (1.40–1.77) Chronic kidney disease41,159 (8.3)1,634 (7.5)580 (3.4)0.97 (0.81–1.17) Chronic liver disease15,868 (3.2)825 (3.8)623 (3.7)1.23 (1.03–1.47) Chronic obstructive pulmonary disease23,048 (4.6)1,481 (6.8)607 (3.6)1.04 (0.87–1.25) Congestive heart failure38,111 (7.7)1,655 (7.6)575 (3.4)0.88 (0.73–1.07) Diabetes152,430 (30.7)4,830 (22.1)2,851 (16.7)1.48 (1.36–1.63) HIV1,361 (0.3)82 (0.4)48 (0.3)3.68 (2.06–6.57) History of malignancy68,267 (13.7)3,013 (13.8)2,119 (12.4)1.21 (1.09–1.34) Psoriatic arthritis——1,872 (11.0)1.40 (1.25–1.58) History of organ transplantation3647 (0.7)100 (0.5)58 (0.3)1.47 (0.86–2.53)Abbreviations: HTN, hypertension; NA, not applicable; OR, odds ratio; RA, rheumatoid arthritis.1 Value in this column are n (%), except for age, which is mean (standard deviation). Open table in a new tab Abbreviations: HTN, hypertension; NA, not applicable; OR, odds ratio; RA, rheumatoid arthritis. After controlling for age and sex, patients with chronic hypertension had similar odds of receiving an influenza vaccination as patients with psoriasis (odds ratio = 0.98, 95% CI = 0.94–1.02). Adults with rheumatoid arthritis were approximately 10% more likely to receive a flu vaccination than psoriasis patients (odds ratio = 1.08, 95% CI = 1.03–1.13), after controlling for age, sex, and treatment with systemic therapy; however, the likelihood of receiving a flu vaccination varied by age (Figure 1). For example, a 30-year-old patient with rheumatoid arthritis was 30% more likely to receive an influenza vaccine than a 30-year-old with psoriasis (odds ratio = 1.30, 95% CI = 1.18–1.45), but a 70-year-old patient with rheumatoid arthritis had a similar likelihood of receiving a flu vaccination as a 70-year-old with psoriasis. In psoriasis patients, factors associated with the receipt of vaccine, including medical comorbidities identified by the Centers for Disease Control and Prevention as high risk for developing influenza-related complications, were examined. In the multivariable model, eight factors were associated with increased likelihood of receiving an influenza vaccine: age, female sex, and history of asthma, chronic liver disease, diabetes, HIV, cancer, and psoriatic arthritis (Table 1). Treatment with a systemic agent (oral systemic agent or biologic therapy) was not associated with an increased likelihood of vaccination. In conclusion, patients with rheumatoid arthritis are more likely to receive a flu vaccine than patients with psoriasis, and this difference is magnified in people younger than 50 years of age. In patients with psoriasis, increasing age, female sex, and having other chronic medical conditions were associated with receipt of a flu vaccine. Additional research is necessary to better understand psoriasis-specific vaccination beliefs and behaviors. In this study, psoriasis patients were younger and had lower rates of certain chronic diseases, including chronic kidney disease, chronic obstructive pulmonary disease, congestive heart failure, and diabetes, which may lead to a lower perception of flu risk. Patient with psoriasis may also have concerns about the safety of receiving vaccinations, especially while on systemic therapies. Additionally, psoriasis patients might not receive adequate counseling from physicians. A survey of American households found the majority of adults who received a vaccination during the 2009–2010 influenza season reported that health care providers were the most influential information source regarding the flu vaccine (Maurer et al., 2010Maurer J. Uscher-Pines L. Harris K.M. Perceived seriousness of seasonal and A(H1N1) influenzas, attitudes toward vaccination, and vaccine uptake among U.S. adults: does the source of information matter?.Prev Med. 2010; 51: 185-187Crossref PubMed Scopus (123) Google Scholar), suggesting dermatologists can potentially be an important resource for psoriasis patients. For younger psoriasis patients, a dermatologist may be the only health care provider they see regularly, making it important for dermatologist to provide counseling about recommended vaccinations. While this is a large, population-based study examining influenza vaccination rates in patients with psoriasis, there are some limitations to the use of administrative claims data to study vaccination rates, including misclassification and lack of generalizability to patients with other types of insurance or without insurance. Further research on understanding why adults with psoriasis do not receive recommended vaccinations will help to create targeted interventions to improve vaccination rates and decrease hospitalizations in adults with psoriasis. Megan H. Noe: http://orcid.org/0000-0001-8481-4711 Joel M. Gelfand served as a consultant for BMS, Boehringer Ingelheim, GSK, Janssen Biologics, Novartis Corp, UCB (DSMB), and Pfizer, receiving honoraria; and receives research grants (to the Trustees of the University of Pennsylvania) from AbbVie, Janssen, Novartis Corp, Celgene, Ortho Dermatologics, and Pfizer; and received payment for continuing medical education work related to psoriasis that was supported indirectly by Lilly and Ortho Dermatologics. Joel M. Gelfand is a Deputy Editor for the Journal of Investigative Dermatology, receiving honoraria from the Society for Investigative Dermatology. The other authors state no conflicts of interest. This work was supported by an early career research grant from the National Psoriasis Foundation (MHN), NIH Training Grant T32-GM075766 (MHN), a career development award from the Dermatology Foundation (MHN) and K24-AR064310 36 (JMG) from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (JMG)." @default.
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• W2897300804 title "Influenza Vaccination Rates in Adults with Psoriasis Compared to Adults with Other Chronic Diseases" @default.
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