The inpatient burden of psoriasis in the United States

Background Although psoriasis has been linked to increased inpatient cardiovascular mortality, little is known about hospitalization for psoriasis and its inpatient burden in the United States in terms of frequency and cost. Objective We sought to determine risk factors for hospitalization for psoriasis and quantify cost of care, length of stay, and in-hospital mortality. Methods We conducted a cross-sectional study of the Nationwide Inpatient Sample from 2002 to 2012, containing a representative 20% sample of all US hospitalizations. Results Hospitalization for psoriasis was associated with nonwhite race (Asian odds ratio [OR] 2.08, 95% confidence interval [CI] 1.55-2.78; black OR 1.65, 95% CI 1.43-1.89; and multiracial/other OR 1.54, 95% CI 1.13-2.11) and insurance status (Medicare OR 1.33, 95% CI 1.26-1.40; Medicaid OR 1.32, 95% CI 1.25-1.40; and uninsured OR 1.94, 95% CI 1.64-2.30). Mean cost of care was lower for a primary diagnosis of psoriasis in comparison with patients without psoriasis ($7433 ± $254 vs $9956 ± $76; P =.002). Length of stay was significantly prolonged for patients with a primary diagnosis of psoriasis compared with no psoriasis (5.4 ± 0.2 vs 4.6 ± 0.02 days; P <.0001). Mean adjusted in-hospital mortality was 0.4% and 1.8% for a primary or no diagnosis of psoriasis, respectively. Limitations We were unable to look at medication usage and its impact on hospitalization. Information regarding the severity of psoriasis and how this may have affected in-hospital procedures was not available. Conclusion There are racial and health care disparities in hospitalization for psoriasis, stressing the need for improved access to dermatologic care for all patients.