Background: Vitiligo affects an estimated 0.5–2% of individuals worldwide and is characterized by cutaneous depigmentation. Recent studies suggest that autoimmune mechanisms in vitiligo extend beyond the skin, including ocular inflammation and auditory dysfunction. Notably, a nationwide Korean cohort of over 140,000 vitiligo patients found significantly elevated risks of dry eye, cataracts, and glaucoma compared with matched controls. However, comprehensive data from diverse U.S. adult populations remain scarce.

Objective: To determine whether adults with vitiligo have increased odds of developing ocular and auditory comorbidities compared with matched controls.

Methods: We conducted a retrospective, matched case–control study using de‑identified EHR data from the NIH All of Us Research Program. We identified cases based on the presence of ≥2 EHR visits with ICD‑10 L80 codes. Controls were matched 4:1 on age, sex, race/ethnicity, and duration of follow-up. We identified ocular outcomes (dry eye syndrome, uveitis, cataracts, glaucoma, retinal diseases, visual impairment) and auditory outcomes (sensorineural and sudden hearing loss, Ménière’s disease, benign paroxysmal positional vertigo, vestibular neuronitis) via validated ICD‑10 codes. Multivariate logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Covariates included body mass index, Charlson Comorbidity Index (CCI), cumulative systemic steroid exposure, hypertension, diabetes, dyslipidemia, and chronic kidney disease. CCI is a validated score that assigns weighted points to chronic conditions based on ICD-10 codes in order to quantify baseline comorbidity burden.

Results: A total of 842 vitiligo cases and 3,368 matched controls were identified. Patients with vitiligo had lower BMI (28.91 vs 29.72 kg/m²; p=0.005), higher rates of long‑term steroid exposure (78.3% vs 56.6%; p<0.001), and higher proportions of CCI>1 (90.1% vs. 78.9%, p<0.001). Patiens with vitiligo patients exhibited higher unadjusted prevalence of any ocular comorbidity (43.2% vs 31.5%) and any auditory comorbidity (20.8% vs 15.9%). In fully adjusted models, vitiligo was associated with dry eye syndrome (aOR 1.39; 95% CI 1.13–1.71; p=0.002), anterior uveitis (aOR 3.00; 95% CI 1.18–7.64; p=0.021), cataracts (aOR 1.22; 95% CI 1.02–1.46; p=0.030), overall retinal disease (aOR 1.27; 95% CI 1.01–1.60; p=0.042), and other retinopathies (aOR 1.39; 95% CI 1.04–1.87; p=0.026). No adjusted associations persisted for any auditory comorbidity (aOR 1.04; 95% CI 0.85–1.27; p=0.703).

Conclusion: This large, multiethnic U.S. cohort demonstrates that vitiligo is independently associated with a spectrum of ocular comorbidities but not with auditory disorders. These findings underscore the need for routine ophthalmologic screening in patients with vitiligo and suggest that interdisciplinary care models may optimize long‑term visual health in this population.