JAMA Dermatol. 2014 Dec;150(12):1298-305. doi: 10.1001/jamadermatol.2014.899.
IMPORTANCE Little is known about population-based risk factors and regional differences for vitiligo.OBJECTIVE To determine the impact of place of birth and residence on vitiligo extent.DESIGN, SETTING, AND PARTICIPANTS A prospective questionnaire-based study using an online questionnaire with 2786 adults (72.2%of whom resided in the United States) with a history of physician-diagnosed vitiligo.EXPOSURES Regions of birth and residence.MAIN OUTCOMES AND MEASURES Body surface area (BSA) of vitiligo lesions.RESULTS Patients with vitiligo who were born outside the United States had lower odds of vitiligo-affected BSA greater than 25%, even after controlling for race/ethnicity, sex, and current age (logistic regression; adjusted odds ratio [aOR], 0.57 [95%CI, 0.46-0.60]).Birthplace in all continents was associated with lower odds of affected BSA greater than 25%than was birthplace in North America. Adults born outside the United States had less affected BSA whether they resided inside (aOR, 0.58 [96%CI, 0.41-0.81]) or outside the United States(aOR, 0.60 [95%CI, 0.48-0.76]). Birthplace and residence at latitudes closer to the equator were associated with lower rates of affected BSA greater than 25%(P .002). The prevalence of affected BSA greater than 25%varied greatly by state of residence (range,27.3%in Maryland to 100% in North Dakota, South Dakota, and Wyoming) (global Moran index = 0.37; P < .001; G statistic = 0.62; P < .001). Spatial regression models that controlled for the regional variation were constructed and confirmed that birthplace outside the United States was associated with lower odds of affected BSA greater than 25%(aOR, 0.61 [95%CI,0.45-0.83]) but not race/ethnicity.CONCLUSIONS AND RELEVANCE There was significant statewide and intercontinental variation for rates of extensive vitiligo. These results suggest that previously unrecognized regional environmental risk factors, especially early in life, play an important role in vitiligo. Additional studies are needed to confirm these early findings and identify such risk factors.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01401374
关于出生地区和居住地对白癜风的影响知之甚少。
确定出生地和居住地对白癜风皮损面积的影响。
设计、地点和参与者： 采用基于在线问卷的前瞻性问卷调查，共纳入 2786 名成人（72.2%的参与者居住在美国），这些人都曾被诊断为白癜风。
出生地和居住地。
白癜风皮损的体表面积（BSA）。
与出生于美国的患者相比，出生于美国以外地区的患者患白癜风皮损面积大于 25%的可能性较小，即使在控制了种族/民族、性别和当前年龄等因素后也是如此（逻辑回归；调整后的优势比[aOR]，0.57[95%CI，0.46-0.60]）。与出生于北美洲相比，出生于所有大陆的人患白癜风皮损面积大于 25%的可能性较小。无论居住在美国境内（aOR，0.58[96%CI，0.41-0.81]）还是境外（aOR，0.60[95%CI，0.48-0.76]），出生于美国境外的成年人患白癜风的皮损面积较小。出生时的纬度越接近赤道，患白癜风皮损面积大于 25%的比例越低（P<.002）。居住州的白癜风皮损面积大于 25%的患病率差异很大（范围从马里兰州的 27.3%到北达科他州、南达科他州和怀俄明州的 100%）（全球 Moran 指数=0.37；P<.001；G 统计量=0.62；P<.001）。构建了控制区域差异的空间回归模型，并证实出生于美国境外与患白癜风皮损面积大于 25%的可能性较低有关（aOR，0.61[95%CI，0.45-0.83]），但与种族/民族无关。
白癜风皮损面积大于 25%的发生率在全州和洲际范围内存在显著差异。这些结果表明，以前未被认识到的区域性环境危险因素，尤其是在生命早期，在白癜风中发挥了重要作用。需要进一步的研究来证实这些早期发现并确定这些危险因素。
clinicaltrials.gov 标识符：NCT01401374
