Hospitalization, Inpatient burden and comorbidities associated with bullous pemphigoid in the United States.

Ren, Z. ; Hsu, D.Y. ; Brieva, J. ; Silverberg, N.B. ; Langan, S.M. ; Silverberg, J.I. ;
Hospitalization, Inpatient burden and comorbidities associated with bullous pemphigoid in the United States.
Br J Dermatol, 2016;

Bullous pemphigoid (BP) is associated with significant disability and comorbid health disorders that may lead to or result from hospitalization. However, little is known about the inpatient burden and comorbidities of BP.

We analyzed data from the 2002-2012 National Inpatient Sample, including a representative 20% sample of all hospitalizations in the US (n=72,108,077 adults).

The prevalences of hospitalization for BP increased from 25.84 to 32.60 cases per million inpatients from 2002 to 2012. In multivariate logistic regression models with stepwise selection, increasing age, non-white race/ethnicity, higher median household income, being insured with Medicare or Medicaid and increasing number of chronic conditions were all associated with hospitalization for BP (P<0.05 for all). The top 3 primary admission diagnoses for patients with a secondary diagnosis of BP were septicemia (prevalence [95% CI]: 5.51 [5.03-5.99]), pneumonia (4.60 [4.19-5.01]) and urinary tract infection (3.52 [3.15-3.89]). BP patients also had numerous autoimmune, infectious, cardiovascular and other comorbidities. Interestingly, BP was associated with multiple neuropsychiatric disorders, including demyelinating disorders, dementias (presenile, senile, vascular and other), paralysis, neuropathy (diabetic, other polyneuropathy), Parkinson’s disease, epilepsy, psychoses and depression. The mean annual age and sex-adjusted in-hospital mortality rate was significantly higher in patients with a secondary diagnosis of BP compared with no BP (2.9% [range: 2.8%-3.9%] vs. 2.1% [range: 1.9%-2.2%]). Significant predictors of mortality in patients with BP included increasing age, non-white race/ethnicity and insurance with Medicaid or other payment status (P<0.05 for all).

Hospitalization for BP increased significantly between 2002 and 2012. Moreover, there were significant racial/ethnic and healthcare disparities with respect to hospitalization and inpatient mortality from BP. This article is protected by copyright. All rights reserved.