Alopecia areata in underrepresented groups: preliminary analysis of the all of us research program.

Alopecia areata (AA) is an autoimmune condition characterized by patchy, nonscarring hair loss. Few studies of AA have adequately included participants from underrepresented groups when evaluating the burden of AA in the United States. We conducted a cross-sectional study of personal/demographic factors and AA using the ongoing All of Us (AoU) Research Program. AoU enrolls adults over 18 years either as direct volunteers or through participating Health Care Provider Organizations by prioritizing recruiting underrepresented groups. We linked data from surveys and electronic health records (EHRs) to estimate the prevalence of AA by race/ethnicity, physical disability, sexual orientation/gender identity (LGBTQIA +), income, and education. The latest AoU release (version 5) includes 329,038 participants. Average age was 51.8 years (standard deviation, SD 16.7), and 60.2% of participants were female. Of these, 251,597 (76.5%) had EHR data and 752 were diagnosed with AA (prevalence, 0.30%; 95% CI 0.28-0.32). We used multivariate logistic regression adjusted for age and other factors to estimate the odds ratio (OR) and 95% confidence intervals (CIs) for prevalence of AA. Compared to Whites, Blacks and Hispanics had higher odds of AA (OR, 1.72; 95% CI 1.39-2.11 and OR, 2.13; 95% CI 1.74-2.59, respectively). Lower odds of AA were observed in participants with less than a high school degree (OR, 0.80; 95% CI 0.59-1.08), household income ≤ $35,000 (OR, 0.67; 95% CI 0.54-0.83), and no health insurance (OR 0.35; 95% CI 0.20-0.56). In this diverse population of US adults, participants with skin of color had higher prevalence of AA. Lower prevalence of AA among individuals with lower education and income levels and those lacking health insurance may reflect limited access to dermatologic care and potentially higher levels of undiagnosed AA in these groups.

Immune-mediated diseases and subsequent risk of alopecia areata in a prospective study of US women.

INTRODUCTION: Alopecia areata (AA) is the most common form of immune-mediated hair loss. Studies have begun to establish the most frequent comorbid diseases of AA; however, results have been inconsistent with few prospective studies. METHODS: A total of 63,692 women in the Nurses' Health Study, 53-80 years, were prospectively followed from 2002 to 2014 to determine whether history of immune-mediated disease was associated with AA risk. Hazard ratios (HRs) and 95% confidence intervals (CIs) for AA in relation to immune-mediated conditions were computed using Cox proportional hazard models, adjusted for AA risk factors. RESULTS: 133 AA cases were identified during follow-up. Personal history of any immune-mediated disease was associated with increased AA risk (HR 1.72, 95% CI 1.24-2.37). History of systemic lupus erythematosus (HR 5.43, 95% CI 2.11-13.97), multiple sclerosis (HR 4.10, 95% CI 1.40-11.96), vitiligo (HR 3.13, 95% CI 1.08-9.10), psoriasis (HR 2.01, 95% CI 1.00-4.03), hypothyroidism (HR 1.88, 95% CI 1.30-2.71), and rheumatoid arthritis (HR 1.66, 95% CI 1.09-2.52) were associated with increased AA risk. History of inflammatory bowel disease or Graves' disease/hyperthyroidism was not significantly associated with AA risk. CONCLUSIONS: In this prospective study, personal history of immune-mediated diseases either individually or overall was associated with increased AA risk.

Racial disparities in the management of skin ulcers: an analysis of the National Ambulatory Medical Care Survey, 2012-2018.

PURPOSE: Racial/ethnic differences in health care are pervasive in the USA, but the literature is limited with regards to racial disparities in the treatment of dermatologic diseases. MATERIALS AND METHODS: Data on the management of skin ulcers was analyzed from the National Ambulatory Medical Care Survey (NAMCS) from 2012 to 2018. Data distributions between Blacks and Whites, chi-squared statistics, and Fisher Exact Tests were computed to identify significant differences in demographic factors, patient encounter characteristics, and medication prescribed, as a function of race. RESULTS: Blacks were less likely than Whites to receive: care by a physician (p = .0389), a skin examination (p < .0001), or cryotherapy (p < .0175). Blacks were more likely to be seen by a nurse practitioner (p = .0359). Whites were 6.698 times more likely than Blacks to have a follow up visit scheduled after 2 months or more. CONCLUSIONS: Our data suggests that among outpatient visits for skin ulcers in the USA, racial disparities exist in the probability of seeing a physician, receiving treatment, and follow-up care. Further research must be conducted and interventions implemented in order to combat racial disparities in Black patients' access to dermatologic treatment for skin ulcers.