Association Between Psoriasis and COVID‐19 in the 2023 National Health Interview Survey

Psoriasis, a chronic inflammatory skin condition, may be linked to COVID-19 risk. A 2022 United Kingdom study found increased COVID-19 morbidity and mortality in those with immune-mediated inflammatory diseases, including psoriasis [1]. Additionally, there is growing concern that SARS-CoV-2 infections might trigger or worsen chronic immune-mediated diseases [2]. To our knowledge, recent studies concerning the possible associations between psoriasis and COVID-19 in a large-scale, nationally representative population of the United States have been lacking. We utilised the 2023 National Health Interview Survey to model a nationally representative sample. Our analysis included 29,156 adults (≥ 18 years). The primary outcome variables were history of psoriasis and history of COVID-19 infection. Multivariable logistic regression analyses were constructed with STATA/BE 18.5 and adjusted for confounders including age, education, race, income, sex, cigarette smoking status, body mass index (BMI), and arthritis. In our study, roughly 3% (weighted) of the respondents reported a history of psoriasis. Of those with psoriasis, 60.1% reported having had COVID-19 infection compared to 55.4% of individuals without psoriasis (p < 0.05; Table 1). Further analysis demonstrated a statistically significant association between psoriasis and COVID-19 infection (AOR 1.19; 95% CI: 1.01–1.41; p < 0.05) after adjusting for confounders. Individuals with psoriasis had 19% greater odds of having COVID-19 infection compared to individuals without psoriasis (Table 2). In males, psoriasis was associated with increased odds of COVID-19 infection (AOR: 1.37, 95% CI: 1.06–1.76; p < 0.05) compared to male respondents without psoriasis. There was no significant difference among females with and without psoriasis. Non-Hispanic Black individuals with psoriasis reported double the odds of COVID-19 infection compared to those without psoriasis (AOR: 2.12, 95% CI: 1.02–4.40. p < 0.05). Finally, psoriasis was linked to a 19% higher likelihood of COVID-19 infection in individuals not using immunosuppressants (AOR: 1.19, 95% CI: 1.00–1.42; p = 0.05). However, this increased risk is not seen in patients taking immunosuppressants, where the likelihood of COVID-19 infection is comparable between those with and without psoriasis. Overall, our findings suggest that psoriasis was associated with a higher risk of COVID-19 infection, specifically in males and non-Hispanic Black individuals. Clinicians should be aware that the risk of developing COVID-19 is not uniform across all patients with psoriasis. Our results indicate that individuals with psoriasis who were not taking immunosuppressants had a higher likelihood of COVID-19 infection. This increased risk, however, was not observed in those using immunosuppressants. While this finding suggests a potential difference in COVID-19 risk between these groups, it is important to acknowledge that immunosuppressants encompass a diverse range of therapies with varying effects on immune function. Prior research, including work by Favaro et al. [3] highlights differences in COVID-19 outcomes among different immunosuppressant classes. Therefore, further research is needed to determine whether specific immunosuppressive treatments influence COVID-19 susceptibility in psoriasis patients. Overactivity of the Th1 and TH17 immune responses have been implicated in the mechanisms behind both psoriasis and increased COVID-19 severity [4]; it is possible that immune dysregulation seen in patients with psoriasis may act to increase COVID-19 morbidity, and vice versa [5]. Limitations of this study include reliance on self-reported diagnoses, lack of information on the type and severity of psoriasis, and uncertain timing of psoriasis diagnoses in relation to COVID-19 infection, leaving the directionality of the association ambiguous. Further research is necessary to clarify this directionality and explore whether other comorbidities mediate this relationship. Author Engel conceived and designed the study, performed statistical analyses, and drafted the manuscript. Authors Kellogg and Javadi contributed to data interpretation and manuscript revisions. Author Smogorzewski provided critical feedback and supervised the project. All authors reviewed and approved the final manuscript. The authors received no specific funding for this work. The authors have nothing to report. Authors Engel, Kellogg, and Javadi, have no conflicts of interest to declare. Dr. Smogorzewski is on the advisory board of Novartis. The data that support the findings of this study are openly available through the National Center for Health Statistics at https://www.cdc.gov/nchs/nhis/documentation/2023-nhis.html.