Validation of medical service insurance claims as a surrogate for ascertaining vitiligo cases

Burden of Vitiligo in Canada: Retrospective Analysis of a Canadian Public Claims Database

BACKGROUND

Vitiligo is an autoimmune disease resulting in skin depigmentation. Treatment options are limited.

OBJECTIVES

To examine disease burden and healthcare resource utilization (HCRU) among patients with vitiligo in Québec, Canada.

METHODS

In this retrospective study, data were obtained from the Régie de l'Assurance Maladie du Québec (RAMQ) databases for 125,000 random individuals from January 2010 to December 2019. The International Classification of Diseases, Ninth Revision (ICD-9) diagnostic code [709.x (other skin disorders)] with vitiligo-related treatment was used to identify patients with vitiligo. Patient characteristics and treatments, including treatment type, episodes (treatments used without discontinuation), and sequences (treatment episodes ≥30 days), were assessed. Annualized HCRU and costs (2021 adjusted) included all-cause hospitalization, emergency department visits, outpatient visits, and medications among patients with vitiligo (n = 113) and age- and sex-matched non-vitiligo controls (n = 339).

RESULTS

Of patients with vitiligo (mean age, 50.0 years; 68.1% female) identified using ICD-9 code 709.x with vitiligo-related treatment, 36.3% received ≥4 treatment episodes. Treatment patterns were heterogeneous, with 43 different sequences reported. Annualized mean outpatient visits (16.1 vs 5.5) and all-cause outpatient service costs per patient were significantly higher in the vitiligo versus the control group (CAN$1037 vs CAN$523; P < .01). Total all-cause services costs were higher for patients with vitiligo in the year after versus before diagnosis (CAN$3679 vs CAN$2085; P = .04).

CONCLUSIONS

Vitiligo is associated with significant burden and HCRU among patients in Québec, Canada, who were identified by ICD-9 code 709.x plus vitiligo-related treatment. Measurement of true vitiligo burden remains challenging.

Association Between Natural Hair Color, Race, and Alopecia

INTRODUCTION

Limited epidemiologic data has suggested direct associations between hair pigment, race, and incidence of alopecia areata (AA). Here, we examine the relationship between natural hair color, race, and the lifetime risk alopecia.

METHODS

In this case-control study, we included UK Biobank patients of all races and self-reported hair color with diagnoses of AA, androgenetic alopecia (AGA), or scarring alopecia (SA). Multivariable logistic regression was used to detect differences in lifetime risk.

RESULTS

Findings reveal a significantly increased risk of AA among individuals with black hair compared to dark brown hair (OR 1.71 [95% CI 1.22-2.38], p < 0.001). Those with red or blonde hair showed a decreased risk of AA (0.74 [0.56-0.97]; 0.62 [0.41-0.95], p < 0.05). No racial differences in AA prevalence were observed among individuals with black hair.

CONCLUSIONS

Darker hair colors may be associated with a higher risk of AA, lighter hair colors with a lower risk, and differences in hair color could contribute to previously noted racial variations in AA incidence, potentially influencing dermatologists' perspectives on the disease's epidemiology.

The Assessment of Infection Risk in Patients with Vitiligo Undergoing Dialysis for End-Stage Renal Disease: A Retrospective Cohort Study

Vitiligo is an autoimmune condition that causes patchy skin depigmentation. Although the mechanism by which vitiligo induces immunocompromise is unclear, other related autoimmune diseases are known to predispose those affected to infection. Individuals with vitiligo exhibit epidermal barrier disruption, which could potentially increase their susceptibility to systemic infections; patients with renal disease also show a predisposition to infection. Nevertheless, there is little research addressing the risk of infection in dialysis patients with vitiligo in comparison to those without it. A retrospective analysis was performed on patients with end-stage renal disease (ESRD) in the United States Renal Data System who started dialysis between 2004 and 2019 to determine if ESRD patients with vitiligo are at an increased risk of bacteremia, cellulitis, conjunctivitis, herpes zoster, or septicemia. Multivariable logistic regression modeling indicated that female sex, black compared to white race, Hispanic ethnicity, hepatitis C infection, and tobacco use were associated with an enhanced risk of vitiligo, whereas increasing age and catheter, versus arteriovenous fistula, and access type were associated with a decreased risk. After controlling for demographics and clinical covariates, vitiligo was found to be significantly associated with an increased risk of bacteremia, cellulitis, and herpes zoster but not with conjunctivitis and septicemia.