Vitiligo is associated with mental health disorders, substance abuse, cardiovascular risk factors and events, and venous thromboembolism: analysis of the 2015–2019 nationwide emergency department sample

Abstract

Abstract Vitiligo is a chronic inflammatory depigmenting skin disease that is associated with psychosocial burden and quality of life impact. Previous studies show that patients with vitiligo have an increased likelihood of autoimmune diseases, but they reveal conflicting results regarding mental health disorders, cardiovascular disease, venous thromboembolism and other comorbidities. We sought to investigate the association of vitiligo with a variety of comorbid health disorders. Data were analysed from 2015 to 2019 Nationwide Emergency Department Sample (NEDS), including a representative 20% sample of all emergency department visits in the United States. Vitiligo and comorbidities were identified by using the international classification of disease 10 codes. Associations of vitiligo with various comorbidities were tested using weighted multivariable logistic regression models. The most frequent comorbidities diagnosed in patients presenting to the emergency department with vitiligo were essential hypertension [weighted prevalence (95% confidence interval, CI): 37·0% (34·6–39·0%)], followed by hyperlipidaemia [30·0% (27·7–32·0%)], hypothyroidism [22·9% (20·7–25·0%)], gastro-esophageal reflux disease without esophagitis [19·2% (17·6–21·0%)], history of nicotine dependence [18·1% (16·5–20·0%)], acute kidney failure [16·1% (14·7–18·0%)], atherosclerotic heart disease without angina [14·8% (13·2–17·0%)] and type 2 diabetes mellitus without complications [14·0% (12·1–16·0%)]. In multivariable logistic regression models adjusting for sex, age and insurance status, vitiligo was associated with alcohol use disorder [adjusted odds ratio (95% CI): 1·88 (1·68–2·11)], anxiety spectrum disorders [1·80 (1·65–1·96)], asthma [1·82 (1·65–2·01)], atrial fibrillation [1·49 (1·35–1·65)], coronary artery disease [1·79 (1·63–1·96)], depressive disorders [2·18 (2·00–2·38)], diabetes mellitus [2·65 (2·42–2·91)], myocardial infarction [2·32 (1·98–2·72)], heart failure [2·09 (1·91–2·28)], hyperlipidaemia [2·66 (2·45–2·88)], hypertension [2·16 (1·96–2·39)], hyperthyroidism [12·59 (11·07–14·32)], hypothyroidism [5·46 (4·95–6·02)], peripheral artery disease [2·69 (2·05–3·53)], pneumonia [2·20 (2·00–2·43)], sleep apnoea [2·43 (2·16–2·74)], stroke [1·81 (1·57–2·08)], suicide ideation or attempt [1·67 (1·39–2·01)] and venous thrombosis and pulmonary embolism [2·46 (2·12–2·85)]. These results show that patients with vitiligo have a significantly higher likelihood of comorbid mental health disorders, substance abuse, cardiovascular risk factors and events, and venous thromboembolism.