Presentation (CTI)

OBJECTIVES: Bullous Pemphigoid (BP), an autoimmune blistering disease primarily affecting the elderly is associated with a high comorbidity burden. Previous studies focused on the commercially insured population, and may not be generalizable due to the advanced average age of individuals with BP. This study evaluated the comorbidity burden among BP patients above 65 years with Medicare insurance.
METHODS: A retrospective cohort study was conducted using Medicare claims data between January 2016 - December 2022. BP patients were selected based on presence of: (1) ≥ 2 BP claims ≥ 30 days apart, within 1-year post-index, and (2) continuous Medicare enrollment during a 2-year pre-index period. BP patients were 1:3 propensity score (PS)-matched to control patients without BP using a 5% random sample of the Medicare data. Comorbidities were compared between BP patients and matched controls, pre- and post-index date.
RESULTS: Overall, 2,973 BP patients were identified; the BP cohort had a mean (SD) age of 79.7 (9.5) years, mean (SD) CCI score of 3.3 (2.8) and was 57% female. Compared to matched controls (N = 8,919), BP patients experienced higher rates of cardiac disease (42% vs 35%), dementia (24% vs 14%), depression (28% vs 21%), pneumonia (22% vs 15%), and obesity (27% vs 19%), one-year post-index. Similar rates of pneumonia and cardiac disease were observed in the baseline period, and each increased by 7% in the post-index period. The differences in dementia rates increased by 6%; depression, by 5%; and chronic kidney disease, by 5%.
CONCLUSIONS: Compared to their matched controls, elderly BP patients had higher rates of several neurological, cardiac, psychological, and weight-related conditions, which increased in magnitude after BP was diagnosed. As corticosteroid use is present among nearly all patients, and presents additional risks in patients with these comorbidities, this study highlights the need for targeted therapy to minimize exposure in BP management.