Lifetime incidence and healthcare disparities in alopecia areata: a UK population-based cohort study

Thompson, Andrew R. ORCID: https://orcid.org/0000-0001-6788-7222, Tziotzios, Christos, Nesnas, John, Randall, Rowena, Czachorowski, Maciej and Messenger, Andrew 2024. Lifetime incidence and healthcare disparities in alopecia areata: a UK population-based cohort study. British Journal of Dermatology 191 (6) , pp. 924-935. 10.1093/bjd/ljae307

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Abstract

Background: Alopecia areata (AA) is an immune-mediated form of hair loss that can occur at any age, often with a significant mental health burden. Objectives: We aimed to provide estimates of the lifetime incidence of AA, and the impacts on mental health, healthcare utilization and work-related outcomes, assessing variation across major sociodemographic subgroups. Methods: AA cases were identified in primary care from the UK population-based Oxford-Royal College of General Practitioners Research and Surveillance Centre database (2009–2018). Lifetime incidence of AA was estimated at age 80 years using modified time-to-event models with age as the timescale, overall and stratified by sex, ethnicity, deprivation and geography. Mental health, healthcare utilization and work-related outcomes were assessed in the 2 years after AA diagnosis compared with matched unaffected controls, and stratified by the same sociodemographic subgroups. Results: During the study period, 6961 people developed AA. Overall lifetime incidence of AA was 2.11% [95% confidence interval (CI) 2.06–2.16]. Females had a higher lifetime incidence (2.35%, 95% CI 2.28–2.43) than males (1.88%, 95% CI 1.81–1.94). Lifetime incidence was higher in those of Asian ethnicity (5.87%, 95% CI 5.51–6.24), Other (4.5%, 95% CI 3.63–5.31), Mixed (4.4%, 95% CI 3.50–5.37) and Black (3.0%, 95% CI 2.63–3.42) ethnicity, compared with White ethnicity (1.7%, 95% CI 1.68–1.80). Lifetime incidence was highest in those with the greatest deprivation: most-deprived quintile (2.92%, 95% CI 2.77–3.07) compared with least-deprived (1.68%, 95% CI 1.59–1.78). Across sociodemographic subgroups, people with AA of Black ethnicity were most likely to have anxiety (adjusted odds ratio vs. matched controls 2.92, 95% CI 1.71–4.91), and had the greatest risk of time off work (adjusted hazard ratio vs. matched controls 2.54, 95% CI 1.80–3.56). Conclusions: AA affects around 1 in 50 people over their lifetime. The incidence and impact of AA on mental health and work outcomes is highest in ethnic groups other than White. Clinicians should be aware of the marked heterogeneity in the incidence and impact of AA, and support targeted healthcare to groups at the highest risk of alopecia and its consequences.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Psychology
Publisher:	Oxford University Press
ISSN:	0007-0963
Funders:	Pfizer
Date of First Compliant Deposit:	2 August 2024
Date of Acceptance:	2 August 2024
Last Modified:	10 Dec 2024 10:45
URI:	https://orca.cardiff.ac.uk/id/eprint/171114

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