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Association Between Psoriasis and Food Insecurity Among United States Adults

J Clin Aesthet Dermatol. 2022;15(12):47–48.

by Leah Shin, BA; Jennifer Laborada, BS; Claudia Lee, BS;
Alexander Egeberg, MD, PhD, DMSc; Jashin J. Wu, MD

Ms. Shin is with Loma Linda University School of Medicine in Loma Linda, California. Ms. Laborada and Ms. Lee are with the University of California Riverside School of Medicine in Riverside, California. Dr. Egeberg is with the Department of Dermatology at Bispebjerg Hospital in Copenhagen, Denmark. Dr. Wu is with the Dermatology Research and Education Foundation in Irvine, California.

FUNDING: No funding was provided for this article.

DISCLOSURES: Ms. Shin, Ms. Laborada, and Ms. Lee report no conflicts of interest. Dr. Wu is or has been an investigator, consultant, or speaker for AbbVie, Almirall, Amgen, Arcutis, Aristea Therapeutics, Bausch Health (Ortho Dermatologics), Boehringer Ingelheim, Bristol-Myers Squibb, Dermavant, Dr. Reddy’s Laboratories, Eli Lilly, Galderma, Janssen, LEO Pharma, Mindera, Novartis, Regeneron, Sanofi Genzyme, Solius, Sun Pharmaceutical, UCB, and Zerigo Health. Dr. Egeberg has received research funding from Pfizer, Eli Lilly, Novartis, Bristol-Myers Squibb, AbbVie, Janssen Pharmaceuticals, the Danish National Psoriasis Foundation, the Simon Spies Foundation, and the Kgl Hofbundtmager Aage Bang Foundation, and honoraria as consultant and/or speaker from AbbVie, Almirall, Leo Pharma, Zuellig Pharma Ltd., Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Union Therapeutics, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals.


Patients with psoriasis have increased healthcare costs and comorbidities, leading to an increased socioeconomic burden in this population.1 Thus, we explored the association between psoriasis and food insecurity using National Health and Nutrition Examination Survey (NHANES) data from 2003 to 2006 and 2009 to 2014.

NHANES data was analyzed for years that included diagnosis of psoriasis and food security in its questionnaires. Statistical analyses were performed with SPSS 27. Participants who did not respond “yes” or “no” to diagnosis of psoriasis were excluded. If the participant did not know or refused to answer, the responses were considered missing. Missing values were imputed using linear interpolation and rounded to the nearest integer. A multinomial logistic regression was conducted with the diagnosis of psoriasis as the dependent variable, measures of food security in the last 12 months, such as meals cut or skipped by the respondent or child in the household, not eating for a day, consuming less than the participant should, hunger, and emergency food received, as the independent variables, and age as a covariate.

Participant demographics prior to missing value imputation are shown in Table 1. Those with psoriasis were significantly more likely to have received emergency food from a church, food pantry, food bank, or soup kitchen in the last 12 months (adjusted odds ratio, 1.4; 95% confidence interval, 1.04 to1.87; P=0.026) and a child in the household that had skipped meals in the last 12 months (adjusted odds ratio, 1.59; 95% confidence interval, 1.06 to 2.36; P=.024) compared to those without psoriasis (Table 2). Other measures of food security such as skipped or cut meals, lack of nutrition for a day, and hunger were not significant. Since emergency food requires that one seeks outside resources, it better gauges the gravity of food insecurity. Similarly, skipped meals in a child more accurately shows food security compared to adult measures because it better demonstrates the seriousness of food insecurity. Adults can skip meals for other reasons, such as increased demands at work or dieting. Additionally, skipped meals are less biased than judging a child’s hunger. It is also more serious than cutting a child’s meal, but less extreme than not eating for a whole day. Therefore, it seems that food insecurity is positively associated with psoriasis.

Limitations of this study include use of a questionnaire subject to nonresponse and recall bias. Missing data imputation treats the imputed values as equal to those that were observed, possibly influencing the final statistical analysis. Comorbidities, severity of psoriasis, and disease duration were not assessed, which could have modified the effect of food security. Patients with lower socioeconomic status have decreased access to dermatologic care, so it is important to recognize the link between food insecurity, an indicator of financial hardship, and psoriasis.2 Studies have shown links between food insecurity and cardiovascular risk and immune activation and chronic disease in patients with HIV.3,4 This population deserves more attention because these patients are susceptible to adverse healthcare outcomes due to the lack of resources. 

References

  1. Thomsen SF, Skov L, Dodge R, et al. Socioeconomic Costs and Health Inequalities from Psoriasis: A Cohort Study. Dermatology. 2019;235(5):372–379. 
  2. Vaidya T, Zubritsky L, Alikhan A, et al. 2018. Socioeconomic and geographic barriers to dermatology care in urban and rural US populations. Journal of the American Academy of Dermatology. 78, 406–408.
  3. Vercammen KA, Moran AJ, McClain AC, et al. Food Security and 10-Year Cardiovascular Disease Risk Among U.S. Adults. Am J Prev Med. 2019;56(5): 689–697.
  4. Tamargo JA, Hernandez-Boyer J, Teeman C et al. 2021. Immune Activation: A Link Between Food Insecurity and Chronic Disease in People Living With Human Immunodeficiency Virus. The Journal of Infectious Diseases. 224, 2043–2052. 
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