Healthcare Disparities in Alopecia Areata

Completed

Brief Summary: 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.

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.

Recruitment & Eligibility

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

Primary Outcome Measures

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

Secondary Outcome Measures

Name	Time	Method
Relative Incidence Psychological Therapy	Data was collected retrospectively, assessed up to two years following initial Alopecia Areata diagnosis for each participant	Estimated using Cox proportional hazard regression and reported as adjusted hazard ratio
Relative Incidence of Unemployment	Data was collected retrospectively, assessed up to two years following initial Alopecia Areata diagnosis for each participant	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
Relative Incidence of Time Off Work	Data was collected retrospectively, assessed up to two years following initial Alopecia Areata diagnosis for each participant	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
Relative Incidence of Primary Care Attendances	Data was collected retrospectively, assessed up to two years following initial Alopecia Areata diagnosis for each participant	Estimated using negative binomial regression and reported as adjusted incidence rate ratio
Relative Incidence of Dermatology Referrals	Data was collected retrospectively, assessed up to two years following initial Alopecia Areata diagnosis for each participant	Estimated using Cox proportional hazard regression and reported as Adjusted hazard ratio