Chronic inflammatory skin diseases (CISD) represent a significant burden of skin disease in the United States, and a growing number of studies demonstrate that CISD are associated with multiple comorbidities. However, few studies examined multimorbidity in adults with CISD. We sought to determine whether hospitalized US adults with chronic inflammatory skin disorders have increased multi-morbidity and mortality risk. Data from the 2002–2012 Nationwide Inpatient Sample were analyzed, including a representative 20% sample of US hospitalizations. Charlson comorbidity index (CCI) and mean estimated 10-year survival were calculated. Multivariable linear regression models were constructed with CCI score and mean estimated 10-year survival as the dependent variables and chronic inflammatory skin diagnosis, age and sex as the independent variables. CCI scores were significantly higher in bullous pemphigoid (P = 0.0005) and dermatomyositis (P < 0.0001), lower in hidradenitis suppurativa (P < 0.0001), pemphigus (P < 0.0001), rosacea (P < 0.0001), and not significantly different in atopic dermatitis, alopecia areata, and lichen planus compared to psoriasis. Conversely, the mean estimated 10-year survival was higher in pemphigus (P = 0.0451), lichen planus (P = 0.0352), rosacea (P < 0.0001), lower in bullous pemphigoid and dermatomyositis (P < 0.0001), and similar in atopic dermatitis, alopecia areata, and hidradenitis suppurativa compared to psoriasis. Each CISD had a distinct profile of comorbidities when compared to psoriasis. Hospitalized adults with multiple CISD have increased multimorbidity and decreased 10-year survival. Further studies are needed to develop multidisciplinary strategies aimed at preventing and treating multimorbidity, especially modifiable cardiovascular factors in adults with CISD.
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Data integrity statement
JI Silverberg had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. Study concept and design: JI Silverberg. Acquisition of Data: JI Silverberg, S Narla. Analysis and interpretation of data: S Narla, JI Silverberg, Drafting of the manuscript: S Narla, JI Silverberg. Critical revision of the manuscript for important intellectual content: S Narla, JI Silverberg. Statistical analysis: JI Silverberg, S Narla. Obtained funding: JI Silverberg. Administrative technical or material support: None. Study supervision: None. Financial disclosures: None. Design and conduct of the study? No. Collection, management, analysis and interpretation of data? No. Preparation, review, or approval of the manuscript? No. Decision to submit the manuscript for publication? No.
International Classification of Disease 9th edition Clinical Modification
Chronic obstructive pulmonary disease
Connective tissue disease
Acquired immunodeficiency syndrome
Chronic kidney disease
Transient ischemic attack
Congestive heart failure
Peptic ulcer disease
Nationwide inpatient sample
Charlson Comorbidity Index
Healthcare cost and utilization project
Agency for healthcare research and quality
Chronic inflammatory skin disease
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This publication was made possible with support from the Agency for Healthcare Research and Quality, grant number K12 HS023011, the Dermatology Foundation.
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Narla, S., Silverberg, J.I. Multimorbidity and mortality risk in hospitalized adults with chronic inflammatory skin disease in the United States. Arch Dermatol Res (2020). https://doi.org/10.1007/s00403-020-02043-8
- Bullous pemphigoid
- Atopic dermatitis
- Hidradenitis suppurativa
- Lichen planus
- Alopecia areata
- Chronic inflammatory skin disease