Partner bereavement and risk of psoriasis and atopic eczema: cohort studies in the UK and Denmark

Abstract

Background Stress is commonly cited as a risk factor for psoriasis and atopic eczema, but such evidence is limited. Objectives To investigate the association between partner bereavement (an extreme life stressor) and psoriasis or atopic eczema. Methods We conducted cohort studies using data from the U.K. Clinical Practice Research Datalink (1997-2017) and Danish nationwide registries (1997-2016). The exposed cohort was partners who experienced partner bereavement. The comparison cohort was up to 10 nonbereaved partners, matched to each bereaved partner by age, sex, county of residence (Denmark) and general practice (U.K.). Outcomes were the first recorded diagnosis of psoriasis or atopic eczema. We estimated hazard ratios (HRs) and confidence intervals (CIs) using a stratified Cox proportional hazards model in both settings, which were then pooled in a meta-analysis. Results The pooled adjusted HR for the association between bereavement and psoriasis was 1 center dot 01 (95% CI 0 center dot 98-1 center dot 04) across the entire follow-up. Similar results were found in other shorter follow-up periods. Pooled adjusted HRs for the association between bereavement and atopic eczema were 0 center dot 97 (95% CI 0 center dot 84-1 center dot 12) across the entire follow-up, 1 center dot 09 (95% CI 0 center dot 86-1 center dot 38) within 0-30 days, 1 center dot 18 (95% CI 1 center dot 04-1 center dot 35) within 0-90 days, 1 center dot 14 (95% CI 1 center dot 06-1 center dot 22) within 0-365 days and 1 center dot 07 (95% CI 1 center dot 02-1 center dot 12) within 0-1095 days. Conclusions We found a modest increase in the risk of atopic eczema within 3 years following bereavement, which peaked in the first 3 months. Acute stress may play a role in triggering onset of new atopic eczema or relapse of atopic eczema previously in remission. We observed no evidence for increased long-term risk of psoriasis and atopic eczema following bereavement.