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Comorbidities and inpatient mortality for pemphigus in the U.S.A.
Author(s) -
Hsu D.Y.,
Brieva J.,
Sinha A.A.,
Langan S.M.,
Silverberg J.I.
Publication year - 2016
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.14463
Subject(s) - pemphigus , medicine , odds ratio , confidence interval , comorbidity , logistic regression , cohort , dermatology
Summary Background The morbidity and mortality associated with pemphigus and its treatments have not been fully described. Previous studies have found conflicting results about certain comorbidities and were limited by small sample sizes. Objectives To determine the morbidity and mortality from pemphigus and its treatments in the U.S.A. Methods We examined a cross‐sectional cohort of 87 039 711 hospitalized patients in the U.S.A. to determine the inpatient comorbidities and mortality of pemphigus. Results In multivariate survey logistic regression models adjusting for age, sex and race/ethnicity, pemphigus and its treatments were associated with 39 of 122 comorbidities examined. The disorders most strongly associated with pemphigus were Cushing syndrome [adjusted odds ratio ( OR ) 17·23, 95% confidence interval ( CI ) 2·41–122·90], adrenal insufficiency (4·08, 1·71–9·73), myasthenia gravis (6·92, 2·55–18·79), mucositis (17·19, 7·73–38·22), herpes infection (7·98, 3·62–17·62), fungal infections (4·03, 3·60–4·52), insomnia (18·02, 2·46–131·88) and hidradenitis (5·34, 1·33–21·43). Among malignancies, only leukaemia ( OR 1·56, 95% CI 1·08–2·24) and non‐Hodgkin lymphoma (1·52, 1·15–2·03) were associated with pemphigus, but not any solid organ malignancies. Patients with a secondary diagnosis of pemphigus had higher inpatient mortality (3·20%, 95% CI 2·71–3·69) than those with a primary (1·60%, 1·29–1·91) or no (1·78%, 1·78–1·78) diagnosis of pemphigus ( P < 0·001). Conclusions Pemphigus is associated with increased inpatient mortality, likely through its association with numerous comorbid health conditions. Patients with pemphigus require improved access to dermatological care and increased screening for the myriad of comorbidities.