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Jessica Risser, MD, MPH; Kevan Lewis, MD, MS; Martin A. Weinstock, MD, PhD

Arch Dermatol. 2009;145(9):1005-1008.

Objectives  To identify and analyze trends in bullous disease mortality from 1979 through 2002 in the United States.

Design  Retrospective population-based analysis.

Setting  Mortality records from the Centers for Disease Control and Prevention mortality database.

Participants  Mortality records from 1979 through 2002 for persons who died of bullous disease.

Main Outcome Measures  Age-adjusted mortality rates and trends for 4 bullous disease subgroups: toxic epidermal necrolysis, pemphigoid, pemphigus, and epidermolysis bullosa.

Results  The overall age-adjusted (to the 2000 US standard population) annual mortality rate from bullous diseases of the skin was 0.103 death per 100 000. The average mortality from bullous disorders was 0.098 per 100 000 in 1979 through 1982 and remained stable at 0.099 per 100 000 during the final 4 years of the study, 1999 through 2002. Pemphigoid had a significant increase in mortality from 1979 through 2002, while pemphigus demonstrated a significant decrease in mortality. The mortality rate for toxic epidermal necrolysis was much higher among blacks (0.192 death per 100 000) than whites (0.025 per 100 000) (P < .001), with a mortality rate ratio of 7.57 (95% confidence interval, 6.97-8.21).

Conclusions  Overall mortality from bullous diseases remained stable from 1979 through 2002, although an increasing mortality from pemphigoid and a decreasing mortality from pemphigus occurred during this period. A very large racial disparity in mortality from toxic epidermal necrolysis was observed.

Author Affiliations: Dermatoepidemiology Unit, Veterans Affairs Medical Center (Drs Risser, Lewis, and Weinstock); Department of Dermatology, Rhode Island Hospital (Drs Risser, Lewis, and Weinstock); and Departments of Dermatology (Drs Risser, Lewis, and Weinstock) and Community Health (Dr Weinstock), Brown University; Providence, Rhode Island.

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