Vitiligo may be associated with lower risk for all-cause, cause-specific mortality

Key takeaways:

• Per 10,000 person-years, the vitiligo and control groups had mortality rates of 34.8 and 45.3.
• Compared with the control group, the adjusted risk for all-cause mortality in the vitiligo group was 0.748.

Patients with vitiligo have a significantly lower risk for all-cause and cause-specific mortality compared with matched controls, according to a study.

“There are insufficient data about the mortality of vitiligo compared with the general population,” Hyun Jeong Ju, MD, PhD, of the department of dermatology at St. Vincent’s Hospital, College of Medicine, Catholic University of Korea, and colleagues wrote. “Therefore, we aimed to investigate all-cause and cause-specific mortality of patients with vitiligo compared with controls without vitiligo.”

Drawing from the National Health Insurance Service database and the National Death Registry, the study compared 107,424 patients with incident vitiligo with 537,120 matched controls. In both cohorts, mean age was 48.07 years and 60.4% of patients were women.

Results showed that vitiligo was associated with a reduction in mortality, regardless of several demographic factors. The vitiligo group displayed a mortality rate of 34.8 per 10,000 person-years compared with the control group’s mortality rate of 45.3 per 10,000 person-years.

The 5- and 10-year mortality rates for patients with vitiligo were 1.2% (95% CI, 1.1%-1.2%) and 3.3% (95% CI, 3.1%-3.4%), respectively. Comparatively, the same rates for the control group were 1.7% (95% CI, 1.6%-1.7%) and 4.2% (95% CI, 4.2%-4.3%), respectively.

The risk for all-cause mortality in the vitiligo group was significantly lower than the control group (adjusted HR = 0.748; 95% CI, 0.72-0.778). Mortality risks associated with specific diseases including infectious (aHR = 0.673), oncologic (aHR = 0.817), hematologic (aHR = 0.641), endocrine (aHR = 0.515), neurologic (aHR = 0.602), respiratory (aHR = 0.686), renal/urogenital (aHR = 0.749) and cardiovascular (aHR = 0.693) diseases were all significantly lower in the vitiligo group compared with the control group.

The only diseases that showed a comparable risk in both groups were psychiatric, gastrointestinal and connective tissue diseases.

The authors described the E-values for the estimate and confidence interval — 1.99 and 1.88, respectively — as a “moderately robust” estimate that is less likely to have unmeasured cofounders affecting the relationship outcomes.

The authors postulate that these findings may support the hypotheses that the autoimmune profile of vitiligo provides immune surveillance for the development of cancer and the melanocyte-specific immunity may not cause further damage to internal organs. It is also possible that the treatments used for vitiligo, which are notably devoid of immunosuppressants, could have contributed to the reduction in mortality, according to the study.

“The autoimmunity of vitiligo seems to have a protective effect against infections, inflammation and cancers and further studies will be necessary to confirm this finding,” the authors concluded.