Distinct Mortality Risks in Generalized Pustular Psoriasis and Palmoplantar Pustulosis: A Nationwide,...

Introduction: The differences in all-cause and cause-specific mortality among patients with generalized pustular psoriasis (GPP), palmoplantar pustulosis (PPP), and psoriasis vulgaris (PV) are not well understood. The aim of our study was to compare all-cause and cause-specific mortality in patients with GPP, PPP, and PV.

We conducted a nationwide, retrospective cohort study using data from the Korean National Health Insurance Service and National Death Registry between 2002 and 2022. Patients with GPP, PPP, and PV aged ≥18 years were identified based on ≥3 visits with principal diagnosis codes. Baseline characteristics, including demographics, general health data, socioeconomic status, and comorbidity profiles, were balanced using inverse probability weighting. Participants were followed up from the index date until the occurrence of death, emigration, or the end of the observation period to investigate all-cause and cause-specific mortality.

Multivariate regression analysis showed that patients with GPP had significantly higher all-cause mortality than those with PV (adjusted hazard ratio [aHR], 1.23; 95% confidence interval [CI], 1.20-1.25), while patients with PPP had lower all-cause mortality (aHR, 0.89; 95% CI, 0.87-0.91). GPP was associated with higher cause-specific mortality, particularly from hematologic (aHR, 1.76; 95% CI, 1.27-2.44) and respiratory diseases (aHR, 1.37; 95% CI, 1.30-1.46), whereas PPP patients had lower mortality from gastrointestinal (aHR, 0.57; 95% CI, 0.52-0.63) and infectious diseases (aHR, 0.71; 95% CI, 0.63-0.80). Subgroup and sensitivity analyses confirmed these findings.

GPP is associated with higher all-cause and cause-specific mortality than PV, while PPP is linked to lower mortality, indicating potential epidemiological and biological differences among these subtypes.