The role of gender, race, and ethnicity in psoriasis patients with COVID-19 infection: A cross-sectional study.

What is known about this subject in regard to women and their families? Psoriasis affects men and women equally, with increased incidence in adults compared with children. Psoriasis severity may vary due to demographics, geography, and presence of comorbidities. Comorbid conditions associated with psoriasis, such as cardiovascular and metabolic disease, may increase risk for poor outcomes associated with COVID-19 infection. What is new from this article as messages for women and their families? Female patients with psoriasis did not have increased risk of COVID-19 infection, hospitalization, or mortality compared with female patients without psoriasis. Biologic medications did not increase risk of COVID-19 infection, hospitalization, or mortality in patients with psoriasis. Hispanic patients had significantly higher rates of COVID-19 infection and hospitalization compared with non-Hispanic patients, suggesting racial and ethnic disparities may be exacerbated by the pandemic. Dear Editors, Patients receiving biologic treatments may have reduced hospitalization risk from severe COVID-19 infection1–3; however, data on the risk, racial disparities, and outcomes for COVID-19 in patients with psoriasis is limited. It is postulated that Hispanic and other minority races who are uninsured face barriers to accessing COVID-19 testing and services. We evaluated the rates of COVID-19 infection, hospitalization, and mortality among psoriasis patients in a California-based population. This cross-sectional study used the University of California COVID Research Data Set, a Health Insurance Portability and Accountability Act-limited medical records dataset for patients tested for COVID-19 across University of California medical centers.4 Psoriasis diagnosis, COVID-19 testing, self-reported demographics, hospitalizations (within 2 weeks of COVID-19 test as a marker of infection severity), and mortality were collected. Specific biologic (adalimumab, ustekinumab, secukinumab, guselkumab, and etanercept) and systemic (cyclosporine and methotrexate) treatment for at least 30 days prior to COVID-19 testing were identified. Fisher exact and χ2 tests were used for statistical analysis, with Bonferroni correction used for multiple comparisons. Data from 290,838 patients is included in University of California COVID Research Data Set (March 2020 to October 2020), with a 3.6% (n = 10,438) positive test rate. Of these, 3566 patients had a diagnosis of psoriasis, with a 2.4% (n = 87) positive infection rate; lower than the 3.6% (n = 10,351) infection rate for those without psoriasis (P = .0002) (Table 1). This observation remained true when separately analyzing women (2.2%, P = .036) and men (2.7%, P = .0189) with psoriasis. There were no significant differences in hospitalization or mortality rate for COVID-19 positive psoriasis patients compared to those without psoriasis (P = .5523, P = .1182, respectively). Similarly, female psoriasis patients did not have significantly increased risk for COVID-19 infection, hospitalization, or mortality compared with females without psoriasis. Study results also showed no clear gender predisposition for COVID-19–related infection and complications. Lastly, there was no significant difference in infection, hospitalization, or mortality rate for psoriasis patients on systemic or biologic agents in comparison to psoriasis patients not on these treatments (P > .05) (Table 1). Table 1. - Psoriasis patients within the UC CORDS who tested positive for COVID-19 and had been on medication for psoriasis for at least 30 days prior to COVID-19 test compared with patients without psoriasis and not on medications, respectively (up to October 29, 2020) Variables COVID-19 (+) test Hospitalizations COVID-19 (+)b Mortality COVID-19 (+)c Condition (age range, average age—y) Psoriasis, n (%) Control, n (%)d Pa Psoriasis, n (%) Control, n (%)d Pa Psoriasis, n (%) Control, n (%)d Pa Total (24–89, 51) 87 (2.4) 10,351 (3.6) .0002 19 (21.8) 1999 (19.3) .5523 4 (4.6) 221 (2.1) .1182 Malef 45 (2.7) 5026 (3.8) .0189 13 (28.9) 1114 (22.2) .2801 3 (6.7) 132 (2.6) .1169 Femalef 42 (2.2) 5325 (3.4) .0036 6 (14.3) 885 (16.6) .6855 1 (2.4) 89 (1.7) .5098 Medication (age range, average age—y) On medication, n (%) Control, n (%)e Pa On medication, n (%) Control, n (%)e Pa On medication, n (%) Control, n (%)e Pa Systemic (26–69, 60) 4 (2.9) 83 (2.4) .5761 2 (50.0) 17 (20.5) .2063 0 (0) 4 (4.8) N/A Biologic (16–78, 51) 7 (2.5) 80 (2.4) .9850 1 (14.3) 18 (22.5) 1 0 (0) 4 (5.0) N/A N/A, not applicable; UC CORDS, University of California COVID Research Data Set; wk, weeks; y, years.a.Statistical analysis of those with psoriasis to those without psoriasis using χ2 test for >5 patients or Fisher exact test for <5 patients; significant if 5 or Fisher exact test for <5 patients; significant if