Abstract
OBJECTIVE: The objective of this meta-analysis is to assess the all-cause and cause-specific mortality in patients with psoriasis. METHOD: In accordance with PRISMA guidelines, a systematic search of PubMed, EMBASE, and the Cochrane Library (from inception to March 2025) was conducted. Eligible studies comprised English-language cohort studies comparing mortality risk (HR/OR/RR) in adults with psoriasis versus healthy/non-psoriasis controls. Two reviewers independently screened studies, extracted data, and assessed study quality using the Newcastle-Ottawa Scale. Hazard ratios (HRs) were synthesized using random-effects models in Stata 14.0. Sensitivity analyses, subgroup analyses, and assessments of publication bias (via funnel plots and Egger's test) were also performed. RESULT: A total of 20 studies involving 8825989 participants were included. Psoriasis patients demonstrated significantly increased risks of all-cause mortality [HR=1.19, 95% CI (1.11-1.28), P=0.000], cardiovascular mortality [HR = 1.32, 95% CI (1.11-1.58), P = 0.002], infection-related mortality [HR=1.24, 95% CI (1.13-1.36), P=0.000], and suicide mortality [HR=1.50, 95% CI (1.03-2.19), P=0.034]. The risk of mortality due to neoplasms was marginally elevated but not statistically significant [HR=1.05, 95% CI (0.98-1.12), P=0.151]. No significant associations were found for neurological disease mortality [HR=0.96, 95%CI (0.83-1.11), P=0.976] or accident-related mortality [HR=0.91, 95% CI (0.81-1.02), P=0.629]. Sensitivity analysis supports the findings. Subgroup analyses revealed higher all-cause mortality risks in Europe (HR=1.11) and Asia (HR=1.23), as well as an increased risk with greater disease severity (moderate-to-severe: HR=1.44; severe: HR=1.54). No publication bias was detected. CONCLUSION: Psoriasis is associated with an increased risk of all-cause, cardiovascular, infection-related, and suicide mortality, highlighting the need for enhanced monitoring and targeted interventions to prevent adverse outcomes particularly for individuals with severe psoriasis. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251017192, identifier CRD420251017192.