Elevated Polysocial Risk Score Linked to Increased Psoriasis Risk

An elevated polysocial risk score was associated with a raised risk of psoriasis, with genetic factors serving as a further influence, according to the results of a recent prospective study.¹

Within the analysis of ≥330,000 individuals within the UK Biobank database, a team of investigators found that increased social vulnerability and an unhealthy lifestyle were each synergistically connected to an additional increased risk of psoriasis.

“Our study demonstrated that multiple social risks were independently associated with psoriasis,” wrote the investigative team, led by Xiang Nong, of the department of dermatology, First Affiliated Hospital of Kunming Medical University.

Psoriasis, a chronic immune-mediated inflammatory disorder, leads to systemic inflammation and related comorbidities, including psoriatic arthritis, diabetes, and cardiovascular disease, as well as significant, negative impacts on quality of life. Genetic factors, lifestyle, socioeconomic status, psychosocial factors, and environmental factors often influence disease progression.

Research has identified more than 60 susceptibility loci for psoriasis across genome-wide association studies.² Other evidence suggests unhealthy lifestyles are linked with disease onset and progression, while dietary and lifestyle interventions may lead to improvements in disease severity.³ Socioeconomic status is a known influence on health, but its role in psoriasis remains unclear, as most studies examined the disease without considering the interrelationships between the physical, psychological, and social aspects of psoriasis.

To improve the understanding of the impact of social risks on psoriasis development, a novel polysocial risk score was created to assess individual-level exposure to social determinants of health.¹ Nong and colleagues analyzed the correlation between polysocial risk score and the risk of psoriasis, while also assessing the potential interaction between polysocial risk score, lifestyle factors, and genetic susceptibility.

A total of 331,631 individuals enrolled in the UK Biobank were included for analysis. In order to determine the polysocial risk score, investigators used an accumulative strategy, combining 6 social determinants of health derived from 3 domains: socioeconomic status, psychosocial factors, and neighborhood and living environment frequently linked to incident psoriasis.

For the purpose of analysis, cox proportional hazards models were used to analyze the associations between polysocial risk scores and the incidence of psoriasis. Nong and colleagues established a lifestyle score and a genetic risk score to determine the potential modifying effects of these factors on the relationship between polysocial risk score and the risk of psoriasis.

Upon analysis, compared to those with a low polysocial risk score (≤1), patients with an intermediate polysocial risk score (2 to 4) and a high polysocial risk score (≥5) had 1.20 (95% CI, 1.06 - 1.36) and 1.53 (95% CI, 1.31 - 1.78) times higher risks of developing psoriasis, respectively. Nong and colleagues also found an additive interaction between polysocial risk score and genetic susceptibility.

Individuals with high polysocial risk scores and unhealthier lifestyles had a 2.6-fold higher risk of developing psoriasis than those with lower polysocial risk scores and healthier ones.

“Our results also indicate that greater social vulnerability and unhealthier lifestyle may synergistically contribute to the additional risk of psoriasis,” Nong and colleagues wrote.

References

1. _{Tian R, He Q, Yang Y, Nong X, Wang S. Associations of polysocial risk score, lifestyle and genetic factors with incident psoriasis: a larger-scale prospective cohort study [published online ahead of print, 2023 Nov 14]. Public Health. 2023;225:320-326. doi:10.1016/j.puhe.2023.10.034}
2. _{Elder JT. Expanded Genome-Wide Association Study Meta-Analysis of Psoriasis Expands the Catalog of Common Psoriasis-Associated Variants. J Investig Dermatol Symp Proc. 2018;19(2):S77-S78. doi:10.1016/j.jisp.2018.09.005}
3. _{van Acht MR, van den Reek JMPA, de Jong EMGJ, Seyger MMB. The Effect of Lifestyle Changes on Disease Severity and Quality of Life in Patients with Plaque Psoriasis: A Narrative Review. Psoriasis (Auckl). 2022;12:35-51. Published 2022 Apr 9. doi:10.2147/PTT.S294189}