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. 2023 Oct;13(10):2265-2277.
doi: 10.1007/s13555-023-01001-2. Epub 2023 Sep 5.

Comorbidity Burden Among Patients with Vitiligo in the United States: A Large-Scale Retrospective Claims Database Analysis

Khaled Ezzedine  1   2 , Ahmed M Soliman  3 , Chao Li  3 , Heidi S Camp  3 , Amit G Pandya  4   5
Affiliations

Comorbidity Burden Among Patients with Vitiligo in the United States: A Large-Scale Retrospective Claims Database Analysis

Khaled Ezzedine et al. Dermatol Ther (Heidelb). 2023 Oct.

Abstract

Introduction: Vitiligo is often associated with comorbid conditions that may increase economic burden and affect patients' health-related quality of life. No large-scale study has been published to date using claims databases to evaluate the burden of comorbidities among patients with vitiligo. Herein, we evaluate the comorbidity burden among patients diagnosed with vitiligo from the US.

Methods: This retrospective cohort analysis used the Merative MarketScan Commercial Database. Eligible patients were diagnosed with vitiligo between January 2008 and December 2020 and matched 1:4 (vitiligo:control) with control subjects with no diagnosis of vitiligo between January 2007 and December 2021. Study outcomes were the incidence of comorbidities after matching, adjusted hazard ratios of comorbidity incidence among patients with vitiligo relative to matched control subjects, and time to comorbidity diagnosis or incidence.

Results: Baseline demographics were well balanced between matched vitiligo (n = 13,687) and control cohorts (n = 54,748). Incidence rates of comorbidities were higher among patients compared with control subjects (psychiatric, 28.4% vs 22.8%; autoimmune, 13.4% vs 5.1%; and non-autoimmune, 10.0% vs 7.0%). The most common psychiatric and autoimmune comorbidities in patients with vitiligo compared with control subjects included anxiety (14.3% vs 11.0%, respectively), sleep disturbance (9.1% vs 7.1%), depression (8.0% vs 6.3%), atopic dermatitis (3.1% vs 1.1%), psoriasis (2.7% vs 0.6%), and linear morphea (1.5% vs 0.1%). The risk of developing any psychiatric (hazard ratio 1.31; P < 0.01), autoimmune (hazard ratio 2.77; P < 0.01), or non-autoimmune (hazard ratio 1.45; P < 0.01) comorbidity was significantly higher among patients with vitiligo. Time to diagnosis of most vitiligo comorbidities was 1-3 years, although linear morphea was diagnosed at < 1 year.

Conclusion: Results of this retrospective analysis demonstrated that patients were much more likely to be diagnosed with autoimmune or psychiatric comorbidities following a vitiligo diagnosis, which likely contributed to increased economic burden and lower quality of life.

Keywords: Autoimmune; Comorbidity; Psychiatric; Retrospective; Vitiligo.

Plain language summary

Vitiligo, a long-lasting disorder in which patches of the skin lose color, is often associated with other medical conditions that may lower a patients’ quality of life and increase the cost of caring for patients with the disorder. No large-scale studies are currently available that look at how other medical conditions affect patients with vitiligo. In this study, we determine the occurrence and timing of other medical conditions among patients from the US who have vitiligo. We used the Merative MarketScan Commercial Database, which captures medical and prescription drug data for 145.5 million people in the US. Patients in this study had vitiligo diagnosed between January 2008 and December 2020 and were matched with subjects who did not have vitiligo between January 2007 and December 2021. We looked at the occurrence of other medical conditions among patients with vitiligo compared with subjects without vitiligo and the time it took for another medical condition associated with vitiligo to happen. The authors found that among 13,687 patients with vitiligo and 54,748 subjects without vitiligo, patients with vitiligo were much more likely to have an autoimmune (disorders in which the body’s immune system attacks healthy tissue) or psychiatric (mental, emotional, or behavioral) disorder, which likely contributed to the amount of money needed to care for the condition and reduced quality of life.

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Conflict of interest statement

K. Ezzedine is a consultant for AbbVie, Incyte, La Roche-Posay, Pfizer, Pierre Fabre, Sanofi, and Viela Bio. A.M. Soliman, C. Li, and H.S. Camp are full-time employees of AbbVie Inc. and may hold AbbVie stock and/or stock options. A.M. Soliman is also a co-inventor on AbbVie patents. A.G. Pandya has served as an investigator for Immune Tolerance Network, Incyte, and Pfizer. He is a consultant for AbbVie, Arcutis, Avita Medical, Immune Tolerance Network, Incyte, Pfizer, Trifecta, TWi, Viela Bio, Vyne, and Villaris and holds stock options for Tara Medical and Zerigo Health.

Figures

Fig. 1
Fig. 1
Study design
Fig. 2
Fig. 2
Risk of developing a psychiatric, b autoimmune, and c non-autoimmune comorbidities among patients diagnosed with vitiligo compared with matched controls. HR, hazard ratio. aAdjusted HRs were estimated by Cox regressions controlling for age, obesity, Charlson Comorbidity Index, and region. bOnly statistically significant data are presented in this figure
See this image and copyright information in PMC

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