A Web-Based Survey on Factors for Unvaccination and Adverse Reactions of SARS-CoV-2 Vaccines in Chinese Patients with Psoriasis

Figures & data

Table 1 Characteristics of Patients Vaccinated and Unvaccinated for SARS-CoV-2

Characteristic	Total (N = 788)	SARS-CoV-2 Vaccine
		Unvaccinated (n = 245)	Vaccinated (n = 543)	P
Age (mean ± SD)	40.2 ± 12.3	38.4 ± 13.8	41.1 ± 11.5	0.010
Female (%)	303 (38.5)	95 (38.8)	208 (38.3)	0.900
Education (%)				0.370
Primary /middle school	182 (23.1)	62 (25.3)	120 (22.1)
High school	191 (24.2)	63 (25.7)	128 (23.6)
College or above	415 (52.7)	120 (49.0)	295 (54.3)
Marital status (%)				0.008
Unmarried	171 (21.7)	68 (27.8)	103 (19.0)
Married	563 (71.4)	157 (64.1)	406 (74.7)
Divorced	51 (6.5)	18 (7.3)	33 (6.1)
Widowed	3 (0.4)	2 (0.8)	1 (0.2)
Comorbidities (%)
Hypertension	99 (12.6)	36 (14.7)	63 (11.6)	0.226
Hyperlipidemia	94 (11.9)	28 (11.4)	66 (12.2)	0.771
Diabetes	32 (4.1)	14 (5.7)	18 (3.3)	0.114
Gout	38 (4.8)	13 (5.3)	25 (4.6)	0.670
Type of psoriasis (%)				0.001
Psoriasis vulgaris	638 (80.9)	180 (73.4)	458 (84.3)
Psoriatic arthritis	92 (11.7)	35 (14.3)	57 (10.5)
Pustular psoriasis	18 (2.3)	10 (4.1)	8 (1.5)
Erythrodermic psoriasis	40 (5.1)	20 (8.2)	20 (3.7)
Course of psoriasis, year (%)				0.237
<1	11 (1.4)	6 (2.4)	5 (0.9)
1–5	196 (24.9)	61 (24.9)	135 (24.9)
>5	581 (73.7)	178 (72.7)	403 (74.2)
Body surface area of skin lesion (%)				<0.001
≤3%	407 (51.7)	99 (40.4)	308 (56.7)
3–10%	216 (27.4)	74 (30.2)	142 (26.2)
>10%	165 (20.9)	72 (29.4)	93 (17.1)
TNF-alpha inhibitors use (%)	80 (10.2)	30 (12.2)	50 (9.2)	0.191
IL-17 inhibitors use (%)	162 (20.6)	68 (27.8)	94 (17.3)	0.001
Anxiety (GAD-2 ≥3) (%)	138 (17.5)	61 (24.9)	77 (14.2)	<0.001
Depression (PHQ-2 ≥3) (%)	145 (18.4)	61 (24.9)	84 (15.5)	0.002
Perceived stress (VAS ≥7) (%)	178 (22.6)	72 (29.4)	106 (19.5)	0.002

Abbreviations: SD, Standard Deviation; GAD-2, two-item Generalized Anxiety Disorder; PHQ-2, two-item Patient Health Questionnaire; VAS, visual analogue scale; TNF, tumor necrosis factor alpha; IL, IL-17, interleukin 17.

Table 2 Factors for Unvaccination in Patients with Psoriasis

	Unadjusted Model		Adjusted Model
Factors	OR (95% CI)	P	aOR (95% CI)^a	P^a
Age	0.98 (0.97, 0.99)	0.006	0.97 (0.96, 0.99)	0.002
Marital status
Unmarried	Ref		Ref
Married	0.59 (0.41, 0.84)	0.003	0.85 (0.53, 1.36)	0.495
Divorced	0.83 (0.43, 1.58)	0.565	1.17 (0.56, 2.46)	0.678
Widowed	3.03 (0.27, 34.07)	0.369	6.12 (0.51, 74.10)	0.155
Type of psoriasis
Psoriasis vulgaris	Ref		Ref
Psoriatic arthritis	1.56 (0.99, 2.46)	0.055	2.05 (1.26, 3.32)	0.004
Pustular psoriasis	3.18 (1,24, 8.19)	0.016	3.03 (1.13, 8.13)	0.028
Erythrodermic psoriasis	2.54 (1.34, 4.84)	0.004	2.28 (1.15, 4.51)	0.018
Body surface area of skin lesion
≤3%	Ref		Ref
3–10%	1.62 (1.13, 2.33)	0.009	1.84 (1.27, 2.68)	0.001
>10%	2.41 (1.64, 3.53)	<0.001	2.79 (1.84, 4.21)	<0.001
TNF-α inhibitors use	1.38 (0.85, 2.22)	0.193	1.51 (0.90, 2.52)	0.115
IL-17 inhibitors use	1.84 (1.28, 2.62)	0.001	1.77 (1.21, 2.58)	0.003
Anxiety (GAD-2 ≥3)	2.01 (1.38, 2.93)	<0.001	1.65 (1.10, 2.46)	0.015
Depression (PHQ-2 ≥3)	1.81 (1.25, 2.63)	0.002	1.35 (0.90, 2.01)	0.142
Perceived stress (VAS ≥7)	1.72 (1.21, 2.43)	0.002	1.41 (0.98, 2.05)	0.066

Note: ^aAdjusted for age, educational level, marital status, type of psoriasis, body surface area of skin lesion.

Abbreviations: OR, odds ratio; aOR, adjusted odds ratio; CI, confidence interval; GAD-2, two-item Generalized Anxiety Disorder; PHQ-2, two-item Patient Health Questionnaire; VAS, visual analogue scale; TNF-α, tumor necrosis factor alpha; IL-17, interleukin-17.

Table 3 Adverse Reactions After Vaccination by the Type of Vaccines and Treatment for Psoriasis

Adverse Reactions	Total (n = 543)	Type of Vaccination			Treatment for Psoriasis
		Inactivated Vaccine (n = 486)	Protein Subunit Vaccine (n = 45)	P	Not Receiving a Treatment (n = 88)	Biological Treatment (n = 147)	Traditional Treatment (n = 78)	Topical Treatment (n = 182)	P
Any	167 (30.8)	147 (30.2)	16 (35.6)	0.460	24 (27.3)	40 (27.2)	20 (25.6)	69 (37.9)	0.083
Local	125 (23.0)	108 (22.2)	13 (28.9)	0.308	19 (21.6)	27 (18.4)	12 (15.4)	57 (31.3)	0.010
Pain	114 (20.1)	101 (20.8)	9 (20.0)	0.901	18 (20.5)	26 (17.7)	10 (12.8)	51 (28.0)	0.024
Induration, swelling	15 (2.8)	9 (1.9)	6 (13.3)	<0.001	3 (3.4)	1 (0.7)	2 (2.6)	7 (3.8)	0.241
Itch, redness	6 (1.1)	4 (0.8)	2 (4.4)	0.085	0	1 (0.7)	0	4 (2.2)	0.324
Systemic	89 (16.4)	86 (17.7)	7 (15.6)	0.718	12 (13.6)	25 (17.0)	11 (14.1)	38 (20.9)	0.390
Fatigue	46 (8.5)	40 (8.2)	5 (11.1)	0.701	8 (9.1)	13 (8.8)	3 (3.8)	20 (11.0)	0.328
Rash, itch	24 (4.4)	22 (4.5)	2 (4.4)	0.980	0	6 (4.1)	7 (9.0)	9 (4.9)	0.011
Stuffy, runny nose	14 (2.6)	12 (2.5)	2 (4.4)	0.760	2 (2.3)	7 (4.8)	0	5 (2.7)	0.100
Headache	11 (2.0)	10 (2.1)	1 (2.2)	1.000	1 (1.1)	2 (1.4)	0	6 (3.3)	0.164
Arthralgia	9 (1.7)	9 (1.9)	0	1.000	2 (2.3)	1 (0.7)	2 (2.6)	4 (2.2)	0.605
Diarrhoea	6 (1.1)	6 (1.2)	0	1.000	1 (1.1)	0	0	3 (1.6)	0376
Fever	6 (1.1)	6 (1.2)	0	1.000	0	0	1 (1.3)	3 (1.6)	0.308
Appetite impaired, nausea	3 (0.6)	2 (0.4)	1 (2.2)	0.234	0	1 (0.7)	1 (1.3)	1 (0.5)	1.000
Other	6 (1.1)	6 (1.2)	0	1.000	2 (2.3)	2 (1.4)	0	2 (1.3)	0.725

Table 4 Factors for Deterioration of Psoriasis After Vaccination

Factors	No Deterioration (N = 429), n (%)	Slight Deterioration (N = 90)				Significant Deterioration (N = 24)
		n (%)	OR (95% CI)	aOR (95% CI)^a	P^a	n (%)	OR (95% CI)	aOR (95% CI)^a	P^a
Nonadherence to treatment	70 (16.3)	24 (26.7)	1.87 (1.10, 3.18)	2.02 (1.17, 3.48)	0.012	7 (29.2)	2.11 (0.84, 5.28)	2.42 (0.94, 6.23)	0.068
TNF-alpha inhibitors use	39 (9.1)	7 (7.8)	0.84 (0.37, 1.95)	0.78 (0.33, 1.89)	0.587	4 (16.7)	2.00 (0.65, 6.15)	2.16 (0.64, 7.25)	0.215
IL-17 inhibitors use	79 (18.4)	14 (15.6)	0.82 (0.44, 1.52)	0.76 (0.40, 1.43)	0.386	1 (4.2)	0.19 (0.03, 1.45)	0.17 (0.02, 1.28)	0.085
Anxiety (GAD-2 ≥3)	45 (10.5)	22 (24.4)	2.76 (1.56, 4.89)	2.67 (1.48, 4.82)	0.001	10 (41.7)	6.09 (2.56, 14.52)	5.06 (2.03, 12.65)	0.001
Depression (PHQ-2 ≥3)	51 (11.9)	23 (25.6)	2.54 (1.46, 4.44)	2.33 (1.30, 4.18)	0.005	10 (41.7)	5.29 (2.24, 12.54)	3.90 (1.55, 9.83)	0.004
Perceived stress (VAS ≥7)	70 (16.3)	27 (30.0)	2.20 (1.31, 3.69)	2.19 (1.27, 3.76)	0.005	9 (37.5)	3.08 (1.30, 7.31)	2.38 (0.95, 5.96)	0.064

Note: ^aAdjusted for age, educational level, marital status, type of psoriasis, body surface area of skin lesion.

Abbreviations: OR, unadjusted odds ratio; aOR, adjusted odds ratio; CI, confidence interval; GAD-2, two-item Generalized Anxiety Disorder; PHQ-2, two-item Patient Health Questionnaire; VAS, visual analogue scale; TNF, tumor necrosis factor alpha; IL, IL-17, interleukin 17.

Figure 1 Changes of psoriasis condition after vaccination, stratified by (A) type of vaccines and (B) treatment for psoriasis.