More patients with alopecia areata (AA) are diagnosed with inflammatory and autoimmune diseases and mental health issues compared with individuals without alopecia, according to new findings.¹

These findings resulted from a recent study examining the specific burden of comorbidities on alopecia patients in the US, as well as those with the clinical subtypes alopecia totalis and alopecia universalis. While prior studies exist, this worked as a more large-scale examination.²

The research compared the incidence of different comorbidities in individuals with alopecia compared to those without, and it was authored by Oladayo Jagun, with Pfizer Inc.

“This study aimed to assess the incidence rates (IRs) and prevalence of AA and AA clinical subtypes in the United States, as well as examine the autoimmune and inflammatory diseases and mental health condition burden in patients with AA compared with a matched cohort of patients without AA using a national administrative claims database,”

Background and Findings

The investigators conducted a retrospective observational study using the Optum Clinformatics Data Mart (CDM) database to assess patients with alopecia areata and a matched group without the condition. The database used health claims data from large commercial and Medicare Advantage health plans.

The research team’s study focused on de-identified records, therefore institutional review board approval and patient consent were not required. For inclusion in the study, individuals had to meet criteria such as being enrolled in the CDM database between October of 2016 and September of 2020, being 12 years old at least by the cohort entry date, and having continuous enrollment and follow-up periods.

Patients in the alopecia cohort were identified through the use of specific diagnosis codes for alopecia areata, with subcategories for the various types of alopecia. Patients in the non-AA cohort were matched to patients in the AA cohort based on age, sex, and race.

The investigators gathered demographic data, such as sex, age, calendar year, race, geographic region, ethnicity, and type of insurance. The team also assessed the presence of autoimmune and inflammatory diseases, including issues such as autoimmune thyroiditis, psoriasis, and rheumatoid arthritis, as well as mental health conditions like anxiety disorders and major depressive disorder.

The follow-up period for both of the study’s cohorts lasted until the end of the period of study, death, dropout from the database, or the occurrence of specific endpoints of interest.

The research team examined the background of 3 individuals who did not have alopecia areata and matched them with patients who did have the condition in terms of age, sex, and race. They evaluated autoimmune and inflammatory diseases as well as mental health conditions both initially and up to 2 years following the reference date.

The team’s research ended up including a total of 8,784 alopecia patients, out of which 599 had totalis/universalis, along with 26,352 matched patients without alopecia in general. The incidence rate of alopecia areata was found to be 17.5 per 100,000 person-years, with a specific rate of 1.1 per 100,000 person-years for patients with totalis/universalis and 16.3 per 100,000 person-years for those without.

The prevalence of alopecia was determined to be 54.9 per 100,000 individuals, with a specific prevalence of 3.8 for totalis/universalis and 51.2 for non-totalis/universalis cases. The investigators reported that those diagnosed with alopecia had a higher prevalence of autoimmune and inflammatory diseases, including allergic rhinitis, atopic dermatitis, asthma, and psoriasis, compared to the matched group without alopecia.

Additionally, the research team noted that patients with alopecia exhibited higher proportions of anxiety as well as major depressive disorder compared to individuals without alopecia. Furthermore, the team added that patients with totalis/universalis generally showed a higher prevalence of autoimmune and inflammatory diseases as well as mental health conditions compared to patients with non-totalis/universalis.

“Awareness of these associations could help physicians better assist patients with AA through appropriate comorbidity screenings and treatment management, potentially prior to progression to more extensive clinical subtypes of AA or the development of mental health conditions related to AA diagnosis,” they wrote. “Future research is needed to examine these associations and potential causal relationships between AA and these comorbidities.”

References

1. ^{George, P, Jagun, O, Liu, Q, Wentworth, C, Napatalung, L, Wolk, R, et al. Prevalence of autoimmune and inflammatory diseases and mental health conditions among an alopecia areata cohort from a US administrative claims database. J Dermatol. 2023; 00: 1– 8. https://doi.org/10.1111/1346-8138.16839.}
2. ^{Abedini R, Hallaji Z, Lajevardi V, Nasimi M, Karimi Khaledi M, Tohidinik HR. Quality of life in mild and severe alopecia areata patients. Int J Womens Dermatol. 2018; 4: 91– 4.}