Healthcare Disparities in Alopecia Areata

Healthcare Disparities in Alopecia Areata: UK Population-based Cohort Study

Alopecia areata (AA) is a common immune-mediated non-scarring alopecia often associated with substantial morbidity. There are however, limited population-based data on potential disparities in the burden of AA, including across people of different ethnicities and deprivation.

We aimed to provide the first large-scale, population-based estimate of lifetime risk of AA overall and by important sociodemographic subgroups. As AA is associated with an increased burden of mental health conditions and work-related outcomes (unemployment, time off work), a detailed understanding of the burden of disease in different sociodemographic groups is vital to plan resource provision.

Study Overview

• Status: Completed
• Conditions: Alopecia Areata
• Intervention / Treatment: Other: No intervention

Detailed Description

The overall purpose of the study is to provide an estimate of the cumulative lifetime incidence of AA in the population overall and by important sociodemographic groups. Moreover, to do a subgroup analysis in the AA population to identify health-related disparities across people in different socioeconomic strata, geographical distribution, sex and ethnic groups. The disparities that will be considered are AA associated: Mental health conditions; healthcare utilisation; and work impact (time off work and unemployment).

The cumulative lifetime risk of AA was estimated at age 80 years (approximate life expectancy in the UK) using survival models, with age as the timescale and accounting for the competing risk of death.

The assessment of any associations with baseline characteristics and the outcomes of interest will be assessed using Cox proportional hazards models (time to event outcomes) and Poisson regression (repeated event outcomes) models.

• Study Type: Observational
• Enrollment (Actual): 4052231

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom
    • Momentum Data Limited

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 12 years to 95 years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

All individuals with new onset AA during the study period defined by the presence of at least one disease specific diagnostic code will be eligible for inlcusion in the AA cohort. Controls will be matched people without AA matched on age, sex, geography, ethnicity, socioeconomic status.

Description

Inclusion Criteria:

• Patients aged greater than 12 over the study period.
• Registered with the contributing primary care practice for any duration during the study period

Exclusion Criteria:

• People diagnosed with AA before the study period.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
People with Alopecia Areata; Children and adults aged 12+ with new onset Alopecia Areata registered with a contributing General practitioner (GP) practice during the study period.	Other: No intervention; Observational analysis of usual care only.
People without Alopecia Areata; Children and adults aged 12+ without Alopecia Areata registered with a contributing GP practice during the study period.	Other: No intervention; Observational analysis of usual care only.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Likelihood of Depressive Episodes	Estimated using logistic regression and reported using adjusted odds ratios	Data was collected retrospectively, assessed prior to and up to two years following initial Alopecia Areata diagnosis for each participant
Likelihood of Recurrent Major Depressive Disorder	Estimated using logistic regression and reported using adjusted odds ratios	Data was collected retrospectively, assessed prior to and up to two years following initial Alopecia Areata diagnosis for each participant
Likelihood of Anxiety Disorder	Estimated using logistic regression and reported using adjusted odds ratios	Data was collected retrospectively, assessed prior to and up to two years following initial Alopecia Areata diagnosis for each participant

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Relative Incidence of Primary Care Attendances	Estimated using negative binomial regression and reported as adjusted incidence rate ratio	Data was collected retrospectively, assessed up to two years following initial Alopecia Areata diagnosis for each participant
Relative Incidence of Dermatology Referrals	Estimated using Cox proportional hazard regression and reported as Adjusted hazard ratio	Data was collected retrospectively, assessed up to two years following initial Alopecia Areata diagnosis for each participant
Relative Incidence Psychological Therapy	Estimated using Cox proportional hazard regression and reported as adjusted hazard ratio	Data was collected retrospectively, assessed up to two years following initial Alopecia Areata diagnosis for each participant
Relative Incidence of Unemployment	Unemployment identified by issue of IB113 or ESA113 forms for unemployment. Relative incidence estimated using Cox proportional hazard regression and reported as Adjusted hazard ratio	Data was collected retrospectively, assessed up to two years following initial Alopecia Areata diagnosis for each participant
Relative Incidence of Time Off Work	Time off work identified by recorded issue of Med 3 certificate in primary care. Relative incidence estimated using Cox proportional hazard regression and reported as Adjusted hazard ratio	Data was collected retrospectively, assessed up to two years following initial Alopecia Areata diagnosis for each participant

Collaborators and Investigators

• Sponsor: Momentum Data
• Collaborators: Pfizer; University of Oxford
• Investigators: Study Director: Andrew McGovern, MD, Momentum Data

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2022
• Primary Completion (Actual): July 24, 2024
• Study Completion (Actual): August 6, 2024

Study Registration Dates

• First Submitted: January 11, 2023
• First Submitted That Met QC Criteria: February 3, 2023
• First Posted (Actual): February 14, 2023

Study Record Updates

• Last Update Posted (Actual): June 18, 2025
• Last Update Submitted That Met QC Criteria: May 30, 2025
• Last Verified: May 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathological Conditions, Anatomical; Skin Diseases; Hypotrichosis; Hair Diseases; Alopecia Areata; Alopecia
• Other Study ID Numbers: p068

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Individual patient data is confidential but can be made available in an anonymised form to bone fide researchers subject to the required data protection training and other requirements. All data will remain behind a firewall and will only be available for access through a secured computer network.
• IPD Sharing Time Frame: There is no pre-specified time-frame for data availability; this will be considered on an individual basis for each request.
• IPD Sharing Access Criteria: As above.
• IPD Sharing Supporting Information Type: SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No