Patients With Vitiligo Experience Poorer Quality of Life but Greater Health Care Access, Utilization

Patients with vitiligo are more likely to report worse quality of life but greater health care access and utilization than those without vitiligo, according to a study published in Archives of Dermatological Research.¹

The researchers explained that patients with vitiligo are more likely to experience negative psychosocial effects, like depression, anxiety, and poorer quality of life. Patients with vitiligo may also have limited health care access; past research found that about half of those analyzed received no treatment during their first year after diagnosis.²

Therefore, the researchers conducted a study to explore health care access and utilization among patients with vitiligo; they also analyzed vitiligo’s disease burden on patients.¹ The researchers aimed to investigate whether these outcomes may be mediated by socioeconomic status, race and ethnicity, or related health conditions.

Compared with those without vitiligo, patients with vitiligo have higher health care access and utilization but report a lower quality of life. | Image Credit: Rabizo Anatolii - stock.adobe.com

They conducted their study using survey data from “All of Us,” a research program from the National Institutes of Health that provides a large, longitudinal dataset on US patients.³ The researchers identified patients with vitiligo in the program based on relevant International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), ICD-10-CM, and Systematized Nomenclature of Medicine diagnosis codes in their electronic health records.¹

The study assessed quality of life, health care access, and health care utilization. To assess quality of life, the researchers used responses to a question from the “Overall Health” survey, which asked patients to rate their overall quality of life on a 5-point scale: excellent, very good, good, fair, or poor. The researchers then placed responses into 2 categories: worse (fair or poor) or better (good, very good, or excellent) quality of life.

Similarly, they assessed health care access by using responses to a question from the “Healthcare Access & Utilization” survey, which asked patients if they experienced delayed care during the past calendar year due to various obstacles, including no transportation or the inability to afford the copay. The researchers considered patients to have delayed care if they reported it to be so for any reason.

Lastly, health care utilization was determined based on another “Overall Health” survey response. The researchers designated health care utilization as “yes” if the patient indicated they visited a doctor within the past year.

There were 409,218 patients with available data in the All of Us program as of September 2023, 1094 (0.3%) with vitiligo. However, the researchers only analyzed those who completed the “Overall Health” and “Healthcare Access & Utilization” surveys; this included 190,209 participants, 573 with vitiligo (52% of the vitiligo population).

Among these patients, those with vitiligo reported having a fair or poor quality of life more often than those without vitiligo (14% vs 11%; P = .037). Conversely, a lower number of patients with vitiligo reported delayed care during the past year due to obstacles (31% vs 36%; P = .020) or not seeing a doctor in the past year (6% vs 11%; P < .001).

Within the vitiligo population, non-Caucasian patients with vitiligo were more likely to report a fair or poor quality of life (24% vs 7%; P < .001) and delayed care due to obstacles (42% vs 26%; P < .001) than Caucasian patients without vitiligo.

Similarly, most demographic and socioeconomic characteristics examined were significantly associated with quality of life, delayed care due to obstacles, and not seeing a doctor. Compared with Caucasian patients with vitiligo, Black patients (OR, 1.08; 95% CI, 1.03-1.13), Hispanic patients (OR, 1.09; 95% CI, 1.04-1.15), and those of other racial/ethnic groups (OR, 1.31; 95% CI, 1.22-1.40) were more likely to report a fair or poor quality of life.

Additionally, Black patients (OR, 1.27; 95% Ci, 1.21-1.33), Hispanic patients (OR, 1.44; 95% CI, 1.38-1.51), and patients of other racial/ethnic groups (OR, 1.32; 95% CI, 1.25-1.39) were more likely to report not seeing a doctor in the past year. Lastly, patients of other racial/ethnic groups were significantly more likely to report delayed care due to obstacles (OR, 1.07; 95% CI, 1.25-1.39), and Black patients were less likely to report delayed care (OR, 0.95; 95% CI, 0.92-0.98).

After adjusting for patient characteristics, the relationships between vitiligo and having a fair or poor quality of life (OR, 1.28; 95% CI, 0.98-1.66), delayed care due to obstacles (OR, 1.04; 95% CI, 0.86-1.26), or not seeing a doctor in the past year (OR, 0.71; 95% CI, 0.50-1.01) were not statistically significant.

The researchers acknowledged their limitations, one being that many vitiligo cases go undiagnosed. Therefore, not all vitiligo cases may be reflected in the All of Us cohort. Despite their limitations, the researchers expressed confidence in their findings.

“These results indicate that while all individuals with vitiligo are affected by their disease, individuals who identify as non-Caucasian may experience an increased impact on quality of life and challenges in health care access and utilization,” the authors concluded. “Incorporating special considerations for these subpopulations in health care practice may lead to improved quality of life outcomes.”

References

1. Crummer E, Cohen JT, Rosmarin D, Lin PJ. Impact on quality of life, health care access, and health care utilization of individuals with vitiligo: an analysis of the All of Us research program. Arch Dermatol Res. 2024;316(8):554. doi:10.1007/s00403-024-03275-8

2. Rosmarin D, Soliman AM, Li C. Real-World Treatment Patterns in Patients with Vitiligo in the United States. Dermatol Ther (Heidelb). 2023;13(9):2079-2091. doi:10.1007/s13555-023-00983-3

3. All of Us Research Program. National Institutes of Health. December 31, 2021. Accessed September 5, 2024. https://allofus.nih.gov/sites/default/files/All%20of%20Us%20Research%20Program%20Operational%20Protocol%202022.pdf