Psychological factors, such as stress, are widely believed to play an important role in the onset of specific, common and important skin diseases, including psoriasis (a scaly rash), eczema, vitiligo (white patches), melanoma skin cancer, alopecia areata (spot baldness) and urticaria (hives). These skin diseases pose a major burden in European countries, and three of them are amongst the top five skin disorders in terms of disability-adjusted life years. Nevertheless, there are few high-quality studies on the importance of stress in the onset of these disorders. This lack of evidence may be explained by the difficulty in measuring stress in epidemiological studies, as the types of life events that are perceived as stressful are very individual. In this health research study, we are interested specifically in stress associated with bereavement of a partner, as it likely to affect most persons negatively regardless of coping mechanisms. We will use data from the UK Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) to compare the risk of each aforementioned six skin diseases among persons who have lost their partner with the risk among persons who have not lost their partner. For melanoma, we will also examine if bereaved persons have a poorer survival than non-bereaved persons.
We will use a matched cohort study to examine if bereavement is associated with the onset of psoriasis, atopic eczema, vitiligo, melanoma, alopecia areata or urticaria. Partners will be defined as two persons with (1) the same family number, (2) opposite sex, (3) an age gap of 10 years or less and (4) no younger adult in the household within 15 years of either of the couple. We will then identify all deaths occurring in the couples during 1997-2014 and the bereaved partner will be classified as bereaved/exposed. The date of bereavement will be considered the index date. Next, we will randomly match five persons to each exposed person by age, sex and general practice. Persons in the matched cohort have to be alive and have a partner but without ever experiencing previous partner bereavement on the index date for the matched exposed person. Using stratified Cox regression, we will compute hazard ratios with 95% confidence intervals for the association between bereavement and each outcome. We will examine if associations depend on risk of partner death (as measured by the age-adjusted Charlson Comorbidity Index) and time since bereavement. For melanoma, we will additionally assess if bereavement is associated with worsened prognosis.
Psoriasis
- Atopic eczema
- Vitiligo
- Melanoma risk and prognosis
- Alopecia areata
- Urticaria
Sinead Langan - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Sinead Langan - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Amy Mulick - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Harriet Forbes - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Henrik Toft Sorensen - Collaborator - Aarhus University
Liam Smeeth - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Sigrún Alba Jóhannesdóttir Schmidt - Collaborator - Aarhus University Hospital
Yun "Angel" Wong - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation