The lifetime risk and impact of vitiligo across sociodemographic groups: a UK population-based cohort study.

ABSTRACT

BACKGROUND: Vitiligo is an autoimmune skin disorder characterised by depigmented patches of skin, which can have significant psychological impacts. OBJECTIVES: To estimate lifetime incidence of vitiligo, overall, by ethnicity, and across other sociodemographic subgroups, and to investigate the impacts of vitiligo on mental health, work, and healthcare utilisation. METHODS: Incident vitiligo cases were identified in the Optimum Patient Care Database of primary care records in the UK between 01/01/2004 and 31/12/2020. Lifetime incidence of vitiligo was estimated at age 80 using modified time-to-event models with age as the timescale, overall and stratified by ethnicity, sex and deprivation. Depression, anxiety, sleep disturbance, healthcare utilisation and work-related outcomes were assessed in the two years after vitiligo diagnosis compared to matched unaffected controls. RESULTS: 9,460 adults and children were newly diagnosed with vitiligo. Overall cumulative lifetime incidence was 0.92% at age 80 years (95% Confidence Interval [CI] 0.90, 0.94). Cumulative incidence was similar in females 0.94% (95%CI 0.92, 0.97) and males 0.89% (95%CI 0.86, 0.92). There were substantial differences in lifetime incidence across ethnic groups; Asian 3.58% (95%CI 3.38, 3.78), black 2.18% (95%CI 1.85, 2.50), mixed 2.03% (95%CI 1.58, 2.47), other 1.05% (95%CI 0.94, 1.17) and white ethnicity 0.73% (95%CI, 0.71, 0.76).People with vitiligo had an increased risk of depression (adjusted Odds Ratio [aOR] 1.08; 95%CI 1.01, 1.15), anxiety (aOR 1.19; 95%CI 1.09, 1.30), depression or anxiety (aOR 1.10; 95%CI 1.03, 1.17) and sleep disturbance (adjusted Hazard Ratio [aHR] 1.15; 95%CI 1.02, 1.31) compared to matched controls. People with vitiligo also had a greater number of primary care encounters (adjusted incidence rate ratio 1.29; 95%CI 1.26, 1.32) and a greater risk of time off work (aHR 1.15; 95%CI 1.06, 1.24). There was little evidence of disparities in vitiligo related impacts across ethnic subgroups. CONCLUSIONS: Clinicians should be aware of the markedly increased incidence of vitiligo in people of non-white ethnicity. The negative impact of vitiligo on mental health, work and healthcare utilisation highlights the importance of monitoring people with vitiligo to identify those who need additional support.The study protocol for this retrospective observational study was registered with ClinicalTrials.gov (Identifier NCT06097494).