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According to a new study, long-term exposure to air pollutants, such as coarse or fine particulate matter, nitrogen oxides, or nitrogen dioxide, was associated with the risk of incident psoriasis, particularly in those with genetic susceptibility.¹

An understanding of risk factors for psoriasis could aid in its early detection, treatment, and management of comorbidities, such as cardiometabolic diseases, depression, anxiety, and inflammatory bowel diseases.²

While the strongest risk factor for incident psoriasis is genetic, environmental conditions or weight gain may interact with genetic susceptibility to trigger the onset of psoriasis.³

Previous observational studies have shown that levels of air pollution components, including coarse and fine particulate matter (PM), carbon monoxide, nitrogen dioxide (NO2), and sulfur dioxide, were associated with outpatient visits for psoriasis exacerbations.^4-7

Could air pollution also be a trigger for the incidence of psoriasis? The authors of the new study wrote, 鈥淐urrently, there is a lack of long-term prospective studies assessing the impact of air pollution on the incidence of psoriasis as well as a shortage of research into the interaction between exposure to multiple air pollutants and genetic factors in relation to psoriasis risk.鈥�¹

To answer this question, the researchers in China used clinical and genetic data from the UK Biobank and measures of near-surface air pollution based on residence to conduct a prospective study of the association between incident psoriasis and long-term exposure to pollutants and how genetic susceptibility affects this association.¹

Study design

The UK Biobank database contains longitudinal health data for more than 500,000 adults. The cohort population for the new study was followed from inception in 2006 through December 30, 2020. Incident psoriasis was identified by the first occurrence of relevant ICD codes.¹

The UK Biobank also provided polygenic risk scores for psoriasis. Associations with genetic risk included only White participants to limit genetic heterogeneity.¹

Near-surface air pollution levels were determined from data from the UK Department for Environment, Food, and Rural Affairs. The researchers calculated the levels of fine PM with a diameter less than 2.5 渭m (PM2.5), coarse PM with a diameter less than 10 渭m (PM10), nitrogen dioxide (NO2), and nitrogen oxides (NOX) based on residence.¹

Associations were analyzed using time-varying Cox proportional hazards models with adjustment for confounders.¹

Out of the 502,480 individuals in the database, 474,055 were included in the study after excluding those with missing data. The mean (SD) age was 56.54 (8.09) years, and 54.36% were female. Most participants (94.22%) reported White race. Another 1.94% reported Asian race, 1.59% reported Black race, 1.20% reported Chinese race, and 0.58% reported mixed race or ethnicity.¹

During a median follow-up time of 11.91 years the researchers identified 4031 incident cases of psoriasis. Participants in the psoriasis group had higher BMI and lower physical activity scores compared with those without psoriasis (each, P<.001). More participants with psoriasis had a history of tobacco consumption, hypertension, diabetes, or hypercholesterolemia compared with those without psoriasis (each, P<.001).¹

Air pollution and psoriasis risk

The researchers found that PM levels were associated with an increased risk of developing psoriasis. For each increase in IQR increment of PM2.5, the hazard ratio (HR) for the risk of incident psoriasis was 1.41 (95% confidence interval [CI], 1.35-1.46; P<.001). The highest quartile of PM2.5 concentration was associated with double the HR of the lowest quartile (HR, 2.01; 95% CI, 1.83-2.20; P<.001). Similarly, the HR for the risk of psoriasis for each increase in IQR increment of PM10 was 1.47 (95% CI, 1.41-1.52 P<.001), and the HR for the highest quartile compared with the lowest quartile of PM10 concentration was 2.21 (95% CI, 2.02-2.43; P<.001).¹

Exposure to higher NO2 and NOX levels was also associated with the risk of psoriasis. The HR for the risk of psoriasis for each IQR increase in pollutant concentration was 1.28 (95% CI, 1.23-1.33; P<.001) for NO2 and 1.19 (95% CI, 1.14-1.24; P<.001) for NOX. Comparing the highest quartile of pollutant concentration to the lowest, the HR was 1.64 (95% CI, 1.49-1.80; P<.001) for NO2 and 1.34 (95% CI, 1.14-1.24; P<.001) for NOX.¹

The researchers repeated the analysis with a series of modifications. They excluded those with a diagnosis in the first 2 years of follow-up and those with poor health at baseline. They also analyzed only those who had lived more than 5 years at their current address or who did not move during the follow-up. All these analyses gave similar results to the full analysis.¹

Genetic risk and air pollution

The researchers found that participants with high genetic risk for psoriasis who were exposed to the highest levels of pollutants had the greatest risk of incident psoriasis (P<.001 for all trends). Relative to participants with low genetic risk and the lowest quartile of exposure, the HRs for the risk of psoriasis were 4.11 (95% CI, 3.46-4.90; P<.001) for PM2.5, 4.29 (95% CI, 3.61-5.08; P<.001) for PM10, 2.95 (95% CI, 2.49-3.50; P<.001) for NO2, and 2.44 (95% CI, 2.08-2.87; P<.001) for NOX for participants with high genetic risk and the highest quartile of exposure.¹

Furthermore, the researchers found an interaction between genetic risk and quartiles of PM10 levels (P=.002), indicating that the risk of psoriasis is greater than the sum of each risk factor.¹

Study limitations included the potential for selection bias, genetic variants affecting risk that were not incorporated in the polygenic risk score, the lack of racial diversity with potentially different variants in genetic risk, and the lack of information about indoor air pollution or actual exposure.

The researchers concluded that the elevated risk of psoriasis in participants with high genetic risk and exposure to high levels of pollutants 鈥渦nderscores the importance of targeted preventive and health care interventions for populations with heightened genetic risk and substantial exposure to air pollution.鈥�

Speaking on the impacts of air pollution, the authors added 鈥渢here is a need to devise and implement effective interventions aimed at mitigating air pollution and safeguarding individuals from the effects associated with psoriasis.鈥�

Published: September 26, 2024