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

Abstract

BACKGROUND: Vitiligo is an autoimmune skin disorder characterized by depigmented patches of skin, which can have significant psychological impacts. OBJECTIVES: To estimate the 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 utilization. METHODS: Incident cases of vitiligo were identified in the Optimum Patient Care Database of primary care records in the UK between 1 January 2004 and 31 December 2020. The lifetime incidence of vitiligo was estimated at age 80 years using modified time-to-event models with age as the timescale, overall and stratified by ethnicity, sex and deprivation. Depression, anxiety, sleep disturbance, healthcare utilization and work-related outcomes were assessed in the 2 years after vitiligo diagnosis and compared with matched controls without vitiligo. The study protocol for this retrospective observational study was registered with ClinicalTrials.gov (NCT06097494). RESULTS: In total, 9460 adults and children were newly diagnosed with vitiligo during the study period. The overall cumulative lifetime incidence was 0.92% at 80 years of age [95% confidence interval (CI) 0.90-0.94]. Cumulative incidence was similar in female (0.94%, 95% CI 0.92-0.97) and male patients (0.89%, 95% CI 0.86-0.92). There were substantial differences in lifetime incidence across ethnic groups, listed by Office for National Statistics criteria [Asian 3.58% (95% CI 3.38-3.78); Black 2.18% (95% CI 1.85-2.50); Mixed/multiple 2.03% (95% CI 1.58-2.47); Other 1.05% (95% CI 0.94-1.17); and White 0.73% (95% CI 0.71-0.76)]. Compared with matched controls, 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]. 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 belonging to Asian, Black, Mixed/multiple and Other groups. The negative impact of vitiligo on mental health, work and healthcare utilization highlights the importance of monitoring people with vitiligo to identify those who need additional support.