Racial characteristics of alopecia areata in the United States

  • Hemin Lee
    Affiliations
    Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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  • Sun Jae Jung
    Affiliations
    Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea

    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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  • Anisha B. Patel
    Affiliations
    Dermatology Department, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas

    Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Jordan M. Thompson
    Affiliations
    Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
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  • Abrar Qureshi
    Affiliations
    Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island

    Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts

    Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
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  • Eunyoung Cho
    Correspondence
    Reprint requests: Eunyoung Cho, ScD, Box G-D, Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, RI 02912.
    Affiliations
    Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island

    Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts

    Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
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      Background

      Epidemiologic studies on the association between race and alopecia areata (AA) are limited.

      Objective

      To characterize racial differences of AA in the United States.

      Methods

      Cross-sectional study of self-registered AA patients and noncases in the National Alopecia Areata Registry (NAAR). We evaluated odds of AA and its subtypes for 5 ethnic/racial groups using logistic regression. A sex-stratified analysis and a sensitivity analysis among dermatologist-confirmed cases were also performed.

      Results

      We identified 9340 AA patients and 2064 noncases. Compared with whites, African Americans had greater odds of AA (odds ratio, 1.77; 95% confidence interval, 1.37-2.28) and Asians had lower odds (odds ratio, 0.40; 95% confidence interval, 0.32-0.50) of AA. The results were consistent in AA subtypes, dermatologist-confirmed cases, and by sex.

      Limitations

      Residual confounding due to limited number of covariates. Recall or recruitment bias not representative of the entire disease spectrum. Also, outcome misclassification was possible because not all AA cases in the registry were confirmed by dermatologists.

      Conclusion

      Our findings suggest higher odds of AA in African Americans and lower odds in Asians compared with whites. Future studies examining racial disparity in AA from clinical and genetic perspectives are warranted for a better understanding of the disease pathogenesis.

      Key words

      Abbreviations used:

      AA ( alopecia areata), AAP ( alopecia areata persistent), AAT ( alopecia areata transient), AT ( alopecia totalis), AU ( alopecia universalis), CI ( confidence interval), NAAF ( National Alopecia Areata Foundation), NAAR ( National Alopecia Areata Registry), NHS ( Nurses' Health Study), NHSII ( Nurses' Health Study II), OR ( odds ratio)
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