RESUMO
BACKGROUND: Vitiligo is an autoimmune skin disorder characterised by depigmented patches of skin, which can have significant psychological impacts. OBJECTIVES: To estimate lifetime incidence of vitiligo, overall, by ethnicity, and across other sociodemographic subgroups, and to investigate the impacts of vitiligo on mental health, work, and healthcare utilisation. METHODS: Incident vitiligo cases were identified in the Optimum Patient Care Database of primary care records in the UK between 01/01/2004 and 31/12/2020. Lifetime incidence of vitiligo was estimated at age 80 using modified time-to-event models with age as the timescale, overall and stratified by ethnicity, sex and deprivation. Depression, anxiety, sleep disturbance, healthcare utilisation and work-related outcomes were assessed in the two years after vitiligo diagnosis compared to matched unaffected controls. RESULTS: 9,460 adults and children were newly diagnosed with vitiligo. Overall cumulative lifetime incidence was 0.92% at age 80 years (95% Confidence Interval [CI] 0.90, 0.94). Cumulative incidence was similar in females 0.94% (95%CI 0.92, 0.97) and males 0.89% (95%CI 0.86, 0.92). There were substantial differences in lifetime incidence across ethnic groups; Asian 3.58% (95%CI 3.38, 3.78), black 2.18% (95%CI 1.85, 2.50), mixed 2.03% (95%CI 1.58, 2.47), other 1.05% (95%CI 0.94, 1.17) and white ethnicity 0.73% (95%CI, 0.71, 0.76).People with vitiligo had an increased risk of depression (adjusted Odds Ratio [aOR] 1.08; 95%CI 1.01, 1.15), anxiety (aOR 1.19; 95%CI 1.09, 1.30), depression or anxiety (aOR 1.10; 95%CI 1.03, 1.17) and sleep disturbance (adjusted Hazard Ratio [aHR] 1.15; 95%CI 1.02, 1.31) compared to matched controls. People with vitiligo also had a greater number of primary care encounters (adjusted incidence rate ratio 1.29; 95%CI 1.26, 1.32) and a greater risk of time off work (aHR 1.15; 95%CI 1.06, 1.24). There was little evidence of disparities in vitiligo related impacts across ethnic subgroups. CONCLUSIONS: Clinicians should be aware of the markedly increased incidence of vitiligo in people of non-white ethnicity. The negative impact of vitiligo on mental health, work and healthcare utilisation highlights the importance of monitoring people with vitiligo to identify those who need additional support.The study protocol for this retrospective observational study was registered with ClinicalTrials.gov (Identifier: NCT06097494).
RESUMO
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 utilisation 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 using modified time-to-event models with age as the timescale, overall and stratified by sex, ethnicity, deprivation, and geography. Mental health, healthcare utilisation and work-related outcomes were assessed in the two years after AA diagnosis compared to matched unaffected controls, and stratified by the same sociodemographic subgroups . RESULTS: 6,961 people developed AA during the study period. 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 4.47% (95%CI 3.63, 5.31), mixed 4.44% (95%CI 3.50, 5.37) and black 3.03% (95%CI 2.63, 3.42) ethnicity, compared to white ethnicity 1.74% (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 to 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 versus matched controls 2.92, 95%CI 1.71, 4.91), and had the greatest risk of time off work (adjusted Hazard Ratio versus matched controls 2.54, 95%CI 1.80, 3.56). CONCLUSIONS: AA affects around 1 in 50 people over their lifetime. Incidence and the 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.The study protocol for this retrospective observational study was registered with ClinicalTrials.gov (Identifier: NCT05727306).