Prevalence of Psoriasis in Children and Adolescents in the United States: A Claims-Based Analysis
February 2018 | Volume 17 | Issue 2 | Original Article | 187 | Copyright © 2018
Amy S. Paller MD,a Rakesh Singh PhD,b Martin Cloutier MSc,c Marjolaine Gauthier-Loiselle PhD,c Bruno Emond MSc,c Annie Guérin MSc,c and Arijit Ganguli MBA PhDb
aNorthwestern University, Chicago, IL bGlobal Health Economics and Outcomes Research, AbbVie Inc., North Chicago, IL cAnalysis Group, Inc., Montreal, Quebec, Canada
IMPORTANCE: While psoriasis (Ps) is mainly characterized as an adult disease, it can also develop during childhood. However, prevalence estimates of pediatric psoriasis in the United States (US) are lacking. OBJECTIVE: To assess the 2015 annual prevalence of Ps and moderate-to-severe Ps in pediatric individuals in the US. DESIGN: This is a retrospective study based on a large administrative insurance claims database in the US. SETTING: Data were extracted from the Truven Health Analytics MarketScan® Commercial Claims and Encounters database, which covers over 60 million individuals with employer-provided health insurance across the US. PARTICIPANTS: Over 4.3 million of individuals continuously enrolled in their healthcare plan in 2015 and under 18 years of age were included in the study. Intervention(s) for Clinical Trials or Exposure(s) for Observational Studies: Not applicable. Main Outcome(s) and Measure(s): Ps was defined based on medical claims with a diagnosis of Ps (ICD-9-CM: 696.1); moderate-to-severe Ps was defined based on medical or pharmacy claims for a systemic treatment (biologic, conventional systemic, or phototherapy) for Ps. Overall and age- and gender-stratified prevalence was estimated for both Ps and moderate-to-severe Ps. RESULTS: The prevalence of Ps was estimated at 128 cases per 100,000 individuals (95% CI: 124-131), that of moderate-to-severe Ps at 16 cases per 100,000 individuals (95% CI: 15-17) in 2015. For both Ps and moderate-to-severe Ps, prevalence estimates were numerically higher in females than in males (146 per 100,000 vs. 110 per 100,000 and 17 per 100,000 vs. 15 per 100,000) and increased with age, ranging from 30 per 100,000 in the 0-3 year old group to 205 per 100,000 in the 12-17 year old group. CONCLUSION AND RELEVANCE: This study provides robust estimates of the prevalence of pediatric Ps that can inform decisions pertaining to the management of pediatric patients with Ps. J Drugs Dermatol. 2018;17(2):187-194.
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Psoriasis (Ps) is a chronic autoimmune inflammatory disease that can affect the skin of almost any part of the body as well as the nails and scalp.1 It typically presents with well-demarcated, sometimes itchy, erythematous plaques topped with scale, which have been associated with a decreased quality of life.1-3 In the United States (US), Ps is estimated to manifest in 2 to 3% of the adult population, with moderate-to-severe Ps developing in approximately 20% of patients with Ps.2,4,5While Ps has two main peaks of onset at around 20-30 and 50-60 years of age,6,7 it can develop at any age, including during childhood.1 Actually, it is believed that up to 30% of patients present with their first symptoms during childhood and adolescence.8 Although Ps is less frequent among pediatric than adult patients, its impact on their emotional and psychosocial well-being can be devastating. Indeed, children and adolescents with Ps are especially vulnerable to suffer from social discomfort and even be alienated or bullied.9 In particular, the visible and uncomfortable symptoms of Ps can significantly impact the self-esteem of children and adolescents, with deleterious effects often persisting into adulthood.10,11 While milder forms of Ps are typically managed with topical therapies, the American Academy of Dermatology recommends the use of systemic therapies in pediatric patients with moderate-to-severe Ps.12 Yet, these recommendations are based on very limited evidence-based data from randomized clinical trials in pediatric populations. Furthermore, only one systemic medication is currently approved by the US Food and Drug Administration (FDA) for pediatric use, leaving few therapeutic options for pediatric patients suffering from more severe Ps.Given that Ps is mainly considered an adult disease, little is known about the prevalence of Ps among children and adolescents in the US. Previous US studies assessing the prevalence