Effects of country of origin and wave of immigration on prevalence of schizophrenia among first and second-generation immigrants: A 30-year retrospective study.

OBJECTIVES: To compare the rates of schizophrenia among 1st and 2nd generation immigrants from two distinct backgrounds and across sequential periods of immigration. METHODS: A 30-years retrospective cohort study (187,184 individuals) of 1st and 2nd generation East-African immigrants (EAIs) and former Soviet-Union immigrants (FSUIs) who migrated to Israel between 1980 and 2012. EAIs were further divided according to waves of immigration. Period prevalence was calculated between the years 2002-2012. Multivariate logistic regression models were used to examine the association between immigration-related factors and prevalence of schizophrenia (Native-Born Israelis serving as reference group). RESULTS: The prevalence of schizophrenia in 1st generation EAIs and FSUIs was 1.8% and 1.2%, respectively, compared to 1.0% among NBIs (p<0.001). The prevalence of schizophrenia among 2nd generation EAIs and FSUIs was 1.3% and 0.8%, respectively, compared to 0.6% among NBIs (p<0.001). Adjusted odds ratios for developing schizophrenia compared to NBIs were 1.6 (95%CI:1.4-1.8) and 2.1 (95%CI:1.6-2.7), among 1st and 2nd generation EAIs and 1.1 (95%CI:0.9-1.2) and 1.3 (95%CI:1.0-1.8) among 1st and 2nd generation FSUIs respectively. Among EAIs, we observed the highest rate of schizophrenia in the pioneer wave of immigrants with gradual decline across subsequent waves: 2.4%, 1.9% and 1.0% for the 1st, 2nd and 3rd waves of immigration, respectively (p<0.001). CONCLUSIONS: The increased risk for developing schizophrenia among 2nd generation immigrants and among pioneer groups of immigrants emphasizes the importance of persistent investment in acculturation. Further studies elucidating the impact of country of origin and ethnic density on the risk for developing schizophrenia are warranted.

Atopic dermatitis and the metabolic syndrome: a cross-sectional study of 116 816 patients.

BACKGROUND: Data regarding the association between atopic dermatitis (AD) and the metabolic syndrome are controversial. OBJECTIVE: To evaluate the prevalence of the metabolic syndrome and its components in a large group of patients with AD compared to a matched reference group. METHODS: A cross-sectional study of AD patients diagnosed by a dermatologist between 1998 and 2016, and a matched comparison group was performed. We analysed the association between AD and metabolic syndrome, its components and possible complications for the entire study population, adults (age > 18) and adults with moderate-to-severe AD. RESULTS: The study included 116 816 patients with AD and 116 812 comparison enrollees. AD in the entire group of patients and in the adult patients was associated with a higher prevalence of dyslipidaemia and a lower prevalence of diabetes and metabolic syndrome. Moderate and severe AD were associated, respectively, with higher prevalence rates of the metabolic syndrome (17.0% vs. 9.4%), its components (obesity: 22.2% vs. 18.6%; diabetes: 15.9% vs. 9.2%; hypertension 27.9% vs. 15.3%; dyslipidaemia 47.1% vs. 28.5%, all P values < 0.001) and cardiovascular morbidity (all P values < 0.001). Multivariate analysis demonstrated a significant overrepresentation of the metabolic syndrome in moderate-to-severe AD (P = 0.04). CONCLUSIONS: Severely affected patients with AD may have one or more undiagnosed components of metabolic syndrome.

Chronic urticaria and osteoporosis: a longitudinal, community-based cohort study of 11 944 patients.

BACKGROUND: Chronic urticaria (CU) carries many risk factors for osteoporosis, but data on the relationships between CU and osteoporosis are lacking. OBJECTIVES: To evaluate the association between CU and osteoporosis in a large community-based study. METHODS: A nationwide observational longitudinal cohort study was conducted. CU was defined as four pairs of urticaria diagnoses; each pair was recorded within a period of 6 weeks and was registered by physicians in a primary-care setting. Patients with CU and their age- and sex- matched controls were followed for the incidence of osteoporosis and other laboratory data between 2002 and 2017. Data regarding systemic steroid exposure and other relevant risk factors for osteoporosis were obtained. Analyses of risk for osteoporosis were performed in Cox regression models adjusted for age, sex, exposure to systemic corticosteroids, obesity, smoking and hyper- and hypothyroid disease. RESULTS: The study included 11 944 patients with CU and 59 829 controls. During the study's observation period, 1035 (8·7%) patients with CU were diagnosed with osteoporosis, compared with 4046 (6·8%) controls. The adjusted multivariate analysis demonstrated that CU was significantly associated with a higher risk for osteoporosis (hazard ratio 1·23, 95% confidence interval 1·10-1·37, P < 0·001). CONCLUSIONS: CU may impose a risk for osteoporosis. Appropriate targeted screening should be considered.

Incidence and variables associated with short and long-term mortality in patients with systemic lupus erythematosus and sepsis admitted in intensive care units.

Background Infections are common among patients with systemic lupus erythematosus (SLE), and are associated with increased morbidity and mortality. Objectives To determine whether SLE is an independent risk factor for short- and long-term mortality in patients admitted to an intensive care unit (ICU) with sepsis, and to identify the characteristics of SLE patients admitted to an ICU with sepsis. Methods A retrospective age- and sex-matched cohort study, based on data of the SEPSIS-ISR (Sepsis Israel) Registry, an ongoing study that collects data on all patients admitted with sepsis to the ICUs. The primary outcome was to determine whether SLE is an independent risk factor for 30-day and 3-year mortality. Secondary outcomes were 30-day and 3-year survival rates, and the identification of variables associated with mortality within the group of patients with SLE. Results In total, 29 SLE and 87 non-SLE patients (median age 55 years; 79.3% females) were included. The primary sites of infection as well as pathogen distributions were similar between the two groups. The most common infections among the SLE and non-SLE patients were pneumonia (48.3 vs. 31%, p = 0.09), urinary tract infection (20.7 vs. 14.9%, p = 0.56) and peritonitis (13.8 vs. 16.1%, p = 0.77). Severe sepsis and septic shock were diagnosed in 79.3 versus 80.5% ( p = 0.89) and 55.2 versus 33.3% ( p = 0.04) of the SLE and non-SLE patients, respectively. The 30-day and 3-year survival rates did not differ between SLE and non-SLE patients, and were 69 versus 67.8% ( p = 0.79) and 41.4 versus 47.1% ( p = 0.69), respectively. In multivariate Cox regression analysis, age (hazard ratio (HR) = 1.02; 95% confidence interval (CI) 1.00-1.05) and cardiovascular involvement during sepsis (HR = 3.32; 95% CI 1.4-7.86) were significant independent risk factors for 30-day mortality. Multiorgan dysfunction during sepsis admission was associated with increased 3-year mortality (HR = 1.37; 95% CI 1.07-1.75). Conclusions SLE is not an independent risk factor for 30-day or 3-year mortality following ICU admission with sepsis. Increased late mortality was associated with congestive heart failure within the SLE patients alone. None of the SLE-related variables were statistically different between the living and deceased SLE patients.

Psychiatric comorbidities in 3207 patients with hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory disease affecting skin that bears apocrine glands. Only anecdotal reports and a few small studies have demonstrated a possible association between HS and depression, but these studies were uncontrolled or were based on small sample sizes. To the best of our knowledge, the association between HS and other psychiatric disorders has never been investigated. OBJECTIVES: To investigate the association between HS and psychiatric disorders: depression, anxiety, psychoses, schizophrenia and bipolar disorder. METHODS: A cross-sectional study was conducted utilizing the database of Clalit Health Services (over 4,100,000 patients). Case patients were defined as having HS when diagnosed by a dermatologist. Control patients without HS were age and gender matched in a 2 : 1 manner. The proportions of patients with psychiatric diseases were compared between patients with and without HS. The association between HS and psychiatric diseases was assessed in multivariate models using logistic regression analyses. RESULTS: The study included 3207 patients with HS and 6412 age- and gender-matched controls. Depression was diagnosed in 5.9% of patients with HS vs. 3.5% of patients without HS (P < 0.001). Anxiety was diagnosed in 3.9% of patients with HS vs. 2.4% of patients without HS (P < 0.001). These associations were significant after controlling for the confounders age and gender (Depression: OR = 1.7, 95% CI: 1.4-2.1; Anxiety: OR = 1.7, 95% CI: 1.3-2.1). CONCLUSIONS: Hidradenitis suppurativa was associated with depression and anxiety. Dermatologists treating patients with HS should be aware of this important association.

Seborrheic dermatitis and hypertension in adults: a cross-sectional study.

BACKGROUND: Seborrheic dermatitis (SD) is a chronic inflammatory skin disease that shares some features with psoriasis. Previous reports have demonstrated an association between hypertension and psoriasis. Chronic skin inflammation may plays a role in the aetiology of hypertension in both disorders. OBJECTIVE: To evaluate the association between SD and hypertension in an adult large population sample. METHODS: A cross-sectional study was carried out by utilizing the database of Clalit Health Services, a healthcare provider organization for over 4 million enrollees in Israel. All adult patients previously diagnosed with SD were compared with a sample of enrollees without SD regarding the prevalence of hypertension. Patients without SD were frequency matched to SD patients regarding age and sex. Data on other health-related lifestyles and comorbidities were collected. RESULTS: The study included all 9255 patients with SD and 9246 age- and sex-matched patients without SD. The prevalence of hypertension was significantly higher in patients with SD (27.1% vs. 24.7%, P < 0.001, OR = 1.13, 95% CI: 1.05-1.21). A multivariate logistic regression model demonstrated that SD was significantly associated with hypertension after controlling for confounders, including age, sex, socioeconomic status, smoking, diabetes and obesity (multivariate OR = 1.23, 95% CI: 1.12-1.35, P < 0.001). CONCLUSIONS: In this study, an association between SD and hypertension was demonstrated in adults. Many factors can be advocated to explain this association. Genetic predisposition, psychological conditions, lipid abnormalities and chronic inflammation of the skin with a change in cytokine balance should be explored as potential mechanisms.

Risk of Herpes zoster in patients with psoriasis treated with biologic drugs.

BACKGROUND: Little is known about the risk of herpes zoster (HZ), among patients with psoriasis treated with biologic drugs. OBJECTIVE: To determine the incidence of HZ in patients with psoriasis and the association between HZ and use of biologic drugs in these patients. METHODS: The study was performed utilizing the medical database of Clalit Health Services in Israel. The incidence of HZ events was calculated among patients with psoriasis treated with phototherapy, traditional systemic medications and biologic drugs. Incidence rates of HZ events were calculated for each medication, as well as hazard ratios adjusted for age, sex and healthcare utilization burden. RESULTS: Among 22,330 psoriasis patients (215,656 person-years), 1321 HZ cases were diagnosed. The crude incidence rates per 1000 person-years were 6.0 for UVB phototherapy (95% confidence interval (CI), 0-12.8), 10.1 for PUVΑ (1.3-19.0), 5.4 for acitretin (2.2-8.7), 17.0 for methotrexate (10.6-23.4), 13.9 for etanercept (0.3-27.4), 19.3 for infliximab (0-45.8) and 4.6 for controls (CI, 4.3-5.0). No cases of HZ were seen among patients treated with alefacept, efalizumab or adalimumab. In a multivariate analysis, age, female sex, healthcare utilization pattern and corticosteroid treatment were associated with the time to HZ infection. The association of HZ with infliximab approached statistical significance (Hazard ratio: 1.77, 95% CI: 0.92-3.43), but none of the other biologic drugs were significantly associated with the risk of HZ. CONCLUSION: Among patients with psoriasis, treatment with some biologic drugs was associated with a higher incidence of HZ compared with controls, though the difference was not statistically significant.

SCORAD 75: a new metric for assessing treatment outcomes in atopic dermatitis.

OBJECTIVE: The scoring atopic dermatitis (SCORAD) is a well-established severity-scoring tool for atopic dermatitis (AD). Dead Sea climatotherapy (DSC) is a natural selective balneo-phototherapy utilized for many years to treat severe AD. The study's goal was to evaluate the impact of DSC on AD patients through assessment of SCORAD scores and to identify parameters associated with greater improvement. METHODS: The files of 78 European patients (37 male patients and 41 female patients, mean age 37.8 years) with AD undergoing DSC were included in this retrospective study. Three sub-groups were delineated based on disease severity (as determined using the SCORAD). Demographic and clinical parameters as well as treatment characteristics--maximal and cumulative sun exposure doses--were recorded. SCORAD values were again recorded for assessment of treatment response. SCORAD 75 was defined as ≥75% decrease in SCORAD values following therapy. Statistical analysis including logistic regression models was used in multivariable analysis. RESULTS: After an average of 30 days of treatment, mean SCORAD values dropped from 50.5 to 11 (76.7%, P<0.001). 64.1% of all patients, regardless of sub-group, reached SCORAD 75, whereas 78.9% of patients with severe disease achieved this result. In a multivariate logistic regression, factors associated with achieving SCORAD 75 were maximal sun exposure, family history of AD and age at disease onset (P=0.002, P=0.009 and P=0.040 respectively). CONCLUSION: Dead Sea climatotherapy is a particularly effective treatment method for the sub-population of adults with severe AD. The SCORAD 75 can be useful for defining sub-populations in which treatment is more likely to be successful.

A study on the association with hepatitis B and hepatitis C in 1557 patients with lichen planus.

BACKGROUND: Previous reports have demonstrated contradicting results on the association between lichen planus and hepatitis. OBJECTIVES: The aim of this study was to investigate the association between lichen planus and viral hepatitis. METHODS: Patients with lichen planus were compared with controls regarding the prevalence of viral hepatitis in a case-control study using logistic multivariate regression models. The study was performed utilizing the medical database of Clalit Health Services. RESULTS: The study included 1557 lichen planus patients over the age of 20 years and 3115 age- and gender-matched controls. The prevalence of hepatitis C in patients with lichen planus was higher than that in the control group (1.9%, 0.4% respectively, P<0.001). In a multivariate analysis, lichen planus was associated with hepatitis C (OR 4.19, 95% CI 2.21; 7.93). The prevalence of hepatitis B in patients with lichen planus was similar to that in the control group (0.9%, 0.5% respectively, P=0.12). A multivariate analysis revealed that lichen planus was not associated with hepatitis B (OR 1.69, 95% CI 0.82; 3.47). CONCLUSION: Lichen planus is associated with hepatitis C but not with hepatitis B. Physicians who care for patients with lichen planus should consider screening patients with lichen planus for hepatitis C.

Coeliac disease associated with psoriasis.

BACKGROUND: Psoriasis is a chronic inflammatory disorder of the skin reported to be associated with systemic comorbidities. OBJECTIVES: To investigate the association between psoriasis and coeliac disease (CD). METHODS: Patients with psoriasis were compared with age- and sex-matched controls regarding the prevalence of CD in a case-control study. chi(2) and t-tests were used for univariate analysis and a logistic regression model was used for multivariate analysis. The study was performed utilizing the medical database of Clalit Health Services. RESULTS: The study included 12,502 patients with psoriasis aged > 20 years and 24,285 age- and sex-matched controls. The prevalence of CD in patients with psoriasis was increased compared with the prevalence in controls (0.29% and 0.11%, respectively, P < 0.001). In a multivariate analysis psoriasis was associated with CD (odds ratio 2.73, 95% confidence interval 1.65-4.53). CONCLUSIONS: Patients with psoriasis have a greater prevalence of CD than matched controls. Recent studies showed a possibility of undiagnosed CD among patients with psoriasis. Therefore, physicians treating patients with psoriasis should be aware of this possible association.

Lichen planus and dyslipidaemia: a case-control study.

BACKGROUND: Previous reports have demonstrated an association between psoriasis and dyslipidaemia. OBJECTIVES: As lichen planus (LP) is also a chronic inflammatory disorder, we investigated the association between LP and dyslipidaemia in Israel. METHODS: A case-control study was performed utilizing the database of Clalit Health Services, a large healthcare provider organization in Israel. Patients aged 20-79 years who were diagnosed as having LP were compared with a sample of enrollees without LP regarding the prevalence of dyslipidaemia. Data on other health-related lifestyle factors and comorbidities were collected. RESULTS: The study included 1477 patients with LP and 2856 controls without LP. The prevalence of dyslipidaemia was significantly higher in patients with LP (42.5% vs. 37.8%, P = 0.003; odds ratio, OR 1.21, 95% confidence interval, [CI]: 1.06-1.38). A multivariate logistic regression model demonstrated that LP was significantly associated with dyslipidaemia even after controlling for confounders, including age, sex, smoking, hypothyroidism, diabetes, hypertension, socioeconomic status and obesity (multivariate OR 1.34, 95% CI: 1.14-1.57, P < 0.001). CONCLUSIONS: In the present study, LP was found to be associated with dyslipidaemia.

Psoriasis associated with ulcerative colitis and Crohn's disease.

BACKGROUND: Numerous reports have demonstrated the epidemiological, pathogenic, and genetic association between psoriasis and Crohn's disease. Nevertheless, the association between psoriasis and ulcerative colitis was rarely described. OBJECTIVE: This study aims to investigate the association between psoriasis and inflammatory bowel disease. Study design Case-control study. SETTING: The study was performed utilizing the large medical dataset of Clalit Health Services. METHODS: Psoriasis patients were compared to controls regarding the prevalence of inflammatory bowel disease in a case-control study using logistic multivariate models. RESULTS: The study included 12 502 psoriasis patients aged 20 years and above and 24 287 age- and sex-matched controls. The prevalence of both Crohn's disease and ulcerative colitis was significantly higher in psoriasis patients compared with the control group. In multivariate analyses, psoriasis was associated with Crohn's disease [odds ratio (OR), 2.49; 95% confidence interval (95% CI), 1.71-3.62] as well as ulcerative colitis (OR, 1.64; 95% CI, 1.15-2.33). This association was independent of anti-tumour necrosis factor-alpha therapy. CONCLUSION: Psoriasis is associated both with Crohn's disease and ulcerative colitis. Future studies on comorbidities in patients with psoriasis should focus on ulcerative colitis.

Psoriasis and chronic obstructive pulmonary disease: a case-control study.

BACKGROUND: Previous reports have demonstrated an association between psoriasis and the metabolic syndrome. Chronic obstructive pulmonary disease (COPD) has also been associated with the metabolic syndrome. OBJECTIVES: To assess the association between psoriasis and COPD in a population-based case-control study. METHODS: A case-control study was performed utilizing the database of Clalit Health Services, a large healthcare provider organization in Israel. Patients over the age of 20 years who were diagnosed with psoriasis ('cases') were compared with a sample of age- and gender-matched enrollees without psoriasis ('controls') regarding the prevalence of COPD. Group matching was performed. Data on health-related lifestyles and other comorbidities were collected. Chi(2) tests, t-tests and logistic regression models were used to compare between study groups. RESULTS: The study included 12,502 psoriasis cases and 24,287 controls. The prevalence of COPD was significantly higher in patients with psoriasis [5.7% vs. 3.6%, P < 0.001, odds ratio (OR) 1.63, 95% confidence interval (CI) 1.47-1.81]. A multivariate logistic regression model demonstrated that psoriasis was significantly associated with COPD, after controlling for confounders, including age, sex, socioeconomic status, smoking and obesity (adjusted OR 1.27, 95% CI 1.13-1.42, P < 0.001). CONCLUSIONS: In this large, population-based case-control study, psoriasis was found to be associated with COPD. Dermatologists caring for patients with psoriasis should be aware of this association, consult an internist or pulmonologist, and advise the patients to stop smoking and reduce additional risk factors for COPD.

Nonattendance in a dermatology clinic--a large sample analysis.

BACKGROUND: Previous studies have described factors determining non-attendance at dermatology appointments in small sample sizes. OBJECTIVE: To perform an analysis of factors associated with non-attendance in a dermatology clinic in a larger sample. METHODS: Factors determining non-attendance were examined in 52 604 consecutive first-time visits to a dermatology clinic over a period of 44 months. RESULTS: Non-attendance proportion was 27.6%. Among children, non-attendance was associated with waiting for an appointment < 7 days [odds ratio (OR), 1.44], Bedouin sector (OR, 1.30), rural Jewish sector (OR, 0.45) and the treating physician. Among adults, non-attendance was associated with female gender (OR, 1.08), age < 55 years (OR, 1.65), waiting time for an appointment < 7 days (OR, 1.44), timing of the appointment between 1 and 4 pm (OR, 1.13), Bedouin sector (OR, 1.63), rural Jewish sector (OR, 0.46) and the treating physician. CONCLUSION: Non-attendance is common among Bedouins, adult female patients and young adults and is more likely as waiting times become longer. Strategies to reduce non-attendance are needed.

Psoriasis and diabetes: a population-based cross-sectional study.

BACKGROUND: Previous reports have shown an association between psoriasis and the metabolic syndrome, but there are only a few studies on the association between psoriasis and diabetes. OBJECTIVES: To study the association between psoriasis and diabetes. METHODS: A cross-sectional study was performed utilizing the database of Clalit Health Services (CHS). Patients who were diagnosed with psoriasis were compared with CHS enrolees without psoriasis regarding the prevalence of diabetes. Patients with diabetes were identified using the CHS chronic diseases registry. Chi-squared tests were used to compare categorical parameters. Logistic regression models were used for multivariate analyses. RESULTS: The study included 16 851 patients with psoriasis and 74 987 subjects without psoriasis (control patients). The proportion of diabetes was significantly higher in patients above 35 years (P < 0.05). The age-adjusted proportion of diabetes was significantly higher in psoriasis patients as compared to the control group [odds ratio (OR), 1.38, P < 0.05] and was similar in men and women (OR, 1.32, 1.45, respectively). A multivariate logistic regression model showed that psoriasis was significantly associated with diabetes, independently of age and gender (OR, 1.58, P < 0.001). CONCLUSIONS: Our study supports previous reports of an association between psoriasis and diabetes. Dermatologists taking care of patients with psoriasis should be aware of this association and advise the patients to reduce additional risk factors such as smoking, hypertension or dyslipidemia.