Health Care Survey Of Psoriasis In China Based On Global Psoriasis Atlas And An Analysis Of Causality Between Psoriasis And Obesity,Type ? Diabetes

Part?: A survey of Chinese Dermatologists on the Perception of Health Care of PsoriasisBackground.High quality health care and management is crucial for quality of life of patients with psoriasis.Dermatologists are crucial for health care for psoriasis.High-quality team of doctors is the key to achieve high-quality health care of psoriasis.An excellent dermatologist should be familiar with not only the guidelines of psoriasis and clinical diagnosis and treatment of psoriasis,but also with the genetics of psoriasis,epidemiology,new drug development and application in the field.However,studies about the knowledge of Chinese dermatologists on the health care of psoriasis have not been found.Objectives.This survey investigated the awareness of dermatologists about management for psoriasis,epidemiology of psoriasis,the cognitive level of new drug application,guidelines for clinical diagnosis and treatment and other related knowledge.Analyses of differences for psoriasis related knowledge between different social demographic characteristics of dermatologists were performed.The survey tried to find the current problems of health care for psoriasis and to provide evidence and advice to resolve existing conflicts and problems for high quality health care services.Methods.A questionnaire named ‘Psoriasis Health Care' was designed and verified.The questionnaire mainly included familiarity of respondents for the local construction of dermatology,the understanding of the epidemiology of psoriasis,the use of biological agents and the knowledge of psoriasis guidelines.The electronic questionnaire was distributed among dermatologists who registered in the 1st and 2nd Chinese Psoriasis Conference and provided contact information.The participants were divided into groups according to their regions,the level of hospitals,professional titles and years of experience.Comparison of the differences about doctors' perception of various problems related to psoriasis among different groups were performed.Results.From October to November in 2019,dermatologists from 31 provinces/autonomous regions/municipalities participated.A total of 1365 questionnaires were sent to the dermatologists and 1345 valid questionnaires were completed with an effective response rate of 98.53%.More than 50% of the responders did not know the construction of dermatology,such as the exacted number of dermatologists,dermatologic inpatients and outpatients in local regions.The most common way to get dermatological care were free to choose any dermatologists.The average waiting time for regular visits for psoriasis was 1.43 hours.About 5.76% of psoriasis patients treat psoriasis with biologics.About 50% of the participants could give an estimate about the prevalence of psoriasis and psoriasis arthritis in China,less than 5% of respondents could give an exact number.Most participants agreed biosimilars might be applied by more psoriasis of patients,they paid much attention on drug safety and effectiveness of biosimilars.Almost all participants(97.47%)were aware of national psoriasis guidelines and most of them(87.5%)used the rule of tens to evaluate the severity of psoriasis.For the comparison between different groups,the awareness rate in the eastern and northern regions was higher than that in the western and southern regions about the local dermatological medical status,and the difference was statistically significant.The awareness rate of doctors in public hospitals was higher than that in private hospitals,and the differences of the awareness rate in the number of inpatient departments of dermatology and the number of other specialized hospitals between the groups were statistically significant.The awareness rate of chief physicians was higher than that of attending physician and resident physician,and the differences were statistically significant.The awareness rate of senior doctors was higher,and the difference between the number of dermatologists and the number of other specialized hospitals was statistically significant.For the prevalence of psoriasis,doctors in public hospitals had a higher awareness rate than in private hospitals,and the difference in the awareness of prevalence of psoriasis arthritis was statistically significant.Participants with higher professional title and longer medical experience had higher awareness of the prevalence with significant differences.For the knowledge of psoriasis guidelines,dermatologists with higher title and the seniority were more familiar with psoriasis guidelines and the the content of the guidelines.Conclusions.The majority of dermatologists might be unfamiliar with health care for psoriasis in China.They did not know the local construction of dermatology,the prevalence of psoriasis,biologics and other basic knowledge.Most of them seemed to know and used the guidelines of psoriasis,although not all the participants.The awareness of psoriasis health care related problems was higher among dermatologists with higher professional title and seniority.Further education about the professional knowledge of psoriasis under the guidance of senior doctor,deputy director or above are essential for dermatologists to improve professional knowledge of psoriasis and provide high quality health care for patients of psoriasis.Part ?: A survey of clinical characteristics and economic burden of Chinese patients' with psoriasisBackground.Psoriasis causes great physical,emotional and economic burden.Quality of patients' life in general,is often significantly impaired.Skin lesions are generalized and symmetrical,causing itching and dryness.Psoriasis is associated with a number of comorbidities,such as cardiovascular diseases and metabolic diseases.The pain of psoriasis,social exclusion and discrimination psychologically devastate individuals suffering from psoriasis.The health care for patients with psoriasis requires not only treating skin lesions and joint involvement,but also managing common comorbidity and mental illness.The treatments used for psoriasis can be expensive and often not financed by health coverage schemes,which has greatly increased the medical expenses of patients.Inability to work due to psoriasis results in reduction or disappearance of patients' income.The patient's economic burden is heavy.Patients' satisfaction with the health care,satisfaction with the treatment efficacy and the treatment compliance are also directly related to the effect and outcome of treatment.Therefore,it is necessary to develop a comprehensive and systematic individualized treatment program to improve the quality of life of patients with psoriasis and reduce the burden of patients.Objectives.This study explored the risk factors related to psoriasis,the clinical characteristics of patients with psoriasis and common comorbidities with psoriasis.It also explored the economic burden and quality of life of patients with psoriasis.Then the treatment of patients and their satisfaction with the health care were investigated.The difference between mild to moderate and severe patients was analyzed.This study provides an important reference for formulating more reasonable and economical individualized management scheme for patients with psoriasis to reduce patients' burden and improving patients' quality of life.Methods.A questionnaire named “questionnaire for patients of psoriasis” was designed and verified.The questionnaire included basic information of respondents,clinical characteristics,health care of patients and ecnomic burden of patients.Patients with psoriasis were recruited by dermatologists from the Specialised psoriasis outpatients to participate in the electronic questionnaire survey.According to the DLQI score,patients were divided into mild to moderate group and severe group.Chi-square test and non-parametric test were used to compare the differences in clinical characteristics,quality of life and economic burden between the two groups.Logistic regression analysis was used for further analysis about the influence of related factors on the severity of psoriasis.Results.From May to October in 2019,a total of 450 questionnaires were distributed and 437 valid questionnaires were recovered,with an effective response rate of 97.11%.Doctors from 28 provinces/autonomous regions/municipalities participated.The mean score of DLQI was 11.49.According to the DLQI score,199 patients were in the mild to moderate group(45.54%),while 238 patients were in the severe group(54.46%).The mean age of onset was 25.43±12.59 years,and the proportion of patients with the age of onset was the highest(34.32%)at the stage of 20-29 years.The age of onset in women was lower than that in men(P =0.18×10-4),and the mean age of onset in severe patients was lower than that in mild to moderate patients(P =0.78×10-2).The most common triggers of psoriasis were mental stress(51.61%),staying up(45.97%)and infection(22.58%).The most common areas of primary lesions were the head(66.82%),the calves(53.55%)and the back(35.93%).Pruritus(74.37%)was the most common symptom and was more common in severe cases(P < 0.01).Among the respondents,151 patients(34.55%)were with other comorbidities,among which hypertension(9.84%),dyslipidemia(8.47%)and depression(5.49%)were common.Logistics regression analysis suggested that the combination of other diseases would aggravate psoriasis.The more severe the disease was,the more likely it was to be complicated with other systemic diseases(P=2.23×10-4).The number of anxiety and depression patients was 107(24.49%)and 211(48.28%),respectively.The incidence of anxiety and depression symptoms increased with the progress of the disease,and the more serious the disease was,the higher incidence of anxiety and depression was(P< 0.01).A total of 81 patients(18.54%)were out of work due to psoriasis,and nearly half of them(42.54%)were off work due to psoriasis in the past year,with an average of 22.77 days off.In the past five years,a total of 118(27.00%)patients were hospitalized for psoriasis.The more severe the disease was,the more affected the work of the patients.The proportion of severe patients who could not work,who were absent due to psoriasis,and who were hospitalized was higher than that of mild and moderate patients(P < 0.01).The more severe the disease was,the higher the treatment cost was.The monthly treatment cost of severe patients was 1.68 times than that of mild to moderate patients.Monthly treatment cost and treatment cost / income per month of patients with psoriasis were different between in the severe group and the mild to moderate group(P < 0.01).There were 266(60.87%)patients with psoriasis who were not satisfied with the therapeutic effect of their psoriasis,and the proportion of patients with severe psoriasis was higher than that of patients with mild to moderate psoriasis(P < 0.01).Conclusions.The quality of life in psoriasis is seriously impaired.The occurrence of psoriasis for patients with severe psoriasis was earlier than patients with mild to moderate psoriasis.Patients of severe psoriasis were susceptible to mental stress,stay up and infection.They were more likely to develop comorbidity.Patients carried heavy psychological burden,and nearly half of the patients show depressive symptoms.The more serious psoriasis was,the higher proportion of patients developed anxiety and depression.Psoriasis patients carried heavier economic burden.The more serious the disease was,the heavier the burden was.Patients are not satisfied with the treatment effect and medical service.In the future,psoriasis patients need to be provided by higher quality and individual health care to reduce the physical,psychological and economic burden.Part ?: An Analysis of Causal Relationship among Psoriasis,Obesity,and Type 2 Diabetes using Genome-wide Analysis Studies Summary StatisticsBackground.Psoriasis is a systemic disease.It is closely related to metabolic diseases.Metabolic syndrome and its components hypertension,diabetes,obesity,dyslipidemia had been confirmed to have genetic correlations with psoriasis by a large number of epidemiological studies.Psoriasis promotes the development of diabetes and obesity,and diabetes and obesity are also independent risk factors for psoriasis.However,the genetic correlation and causal relationship between psoriasis and diabetes and obesity have not yet been clarified.Objectives.To investigate the possible genetic correlation between Type 2 diabetes(T2D),T2 D adjusted BMI(T2Dadj BMI),T2D-correlated traits and obesity correlated traits with psoriasis;and to investigate the possible causal associations of Type 2 diabetes(T2D),T2 D adjusted BMI(T2Dadj BMI),T2D-correlated traits and obesity correlated traits with psoriasis.Methods.The GWAS summary data was downloaded from public domain or from published articles.The data was downloaded from the largest trans-ethnic genome-wide meta-analysis of psoriasis,and from databases such Genetic Investigation of ANthropometric Traits(GIANT),Early Growth Genetics(EGG),DIAbetes Genetics Replication And meta-analysis(DIAGRAM),and Meta-Analyses of Glucose and Insulin-related traits Consortium(MAGIC).LDSC method was used for estimation about the genetic correlation between psoriasis and T2D/T2 D related traits,psoriasis and obesity related traits.Then,GSMR method was used for estimation about the causal relationship between psoriasis and T2D/T2 D related traits,psoriasis and obesity related traits.Results.We found a significant positive correlation between psoriasis and BMI(rg=0.16,P=3×10-4)by LDSC.Then,the P value was significant(P=2.52×10-4)when psoriasis was regarded as risk factor,BMI was outcome and 24 psoriasis associated SNPs were instruments.The P value was nominal significant(P=0.015)when psoriasis was outcome,BMI was risk factor,and 818 BIM associated SNPs were instruments.No significant results were found in bidirectional GSMR analysis between psoriasis and type 2 diabetes(P>0.05).Conclusions.Our analysis of large summary-level GWAS data from genome wide meta-analysis of psoriasis? DIAGRAM database?MAGIC database?GIANT database?EGG database to explore the genetic correlation and causal relationship between obesity,T2 D and psoriasis.These findings indicated that psoriasis increase the risk of higher BMI,and higher BMI might also lead to psoriasis.There may be a genetic correlation between psoriasis and T2 D,but there is no causal association between them.The correlation may be mediated by BMI.This study has deepened our understanding of biological mechanisms linking psoriasis with obesity and T2D.