斑秃的终身发病率和医疗保健差异：一项基于英国人群的队列研究。

Lifetime incidence and healthcare disparities in alopecia areata: a UK population-based cohort study.

机构信息

South Wales Clinical Psychology Training Programme, Department of Psychology, Cardiff University, Tower Building, Cardiff, Wales.

St John's Institute of Dermatology, King's College London, London, Guy's Hospital, London, UK.

出版信息

Br J Dermatol. 2024 Nov 18;191(6):924-935. doi: 10.1093/bjd/ljae307.

DOI:10.1093/bjd/ljae307

PMID:39104082

Abstract

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 utilization 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 years using modified time-to-event models with age as the timescale, overall and stratified by sex, ethnicity, deprivation and geography. Mental health, healthcare utilization and work-related outcomes were assessed in the 2 years after AA diagnosis compared with matched unaffected controls, and stratified by the same sociodemographic subgroups.

RESULTS

During the study period, 6961 people developed AA. 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 (4.5%, 95% CI 3.63-5.31), Mixed (4.4%, 95% CI 3.50-5.37) and Black (3.0%, 95% CI 2.63-3.42) ethnicity, compared with White ethnicity (1.7%, 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 with 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 vs. matched controls 2.92, 95% CI 1.71-4.91), and had the greatest risk of time off work (adjusted hazard ratio vs. matched controls 2.54, 95% CI 1.80-3.56).

CONCLUSIONS

AA affects around 1 in 50 people over their lifetime. The incidence and 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.

摘要

背景

斑秃是一种可发生于任何年龄的免疫介导性脱发，常伴有严重的心理健康负担。

目的

我们旨在提供斑秃终生发病率的估计值，并评估其对心理健康、医疗保健利用和与工作相关的结局的影响，同时评估主要社会人口亚组之间的差异。

方法

我们从英国基于人群的牛津皇家全科医师学院研究和监测中心数据库（2009-2018 年）中确定了初级保健中的斑秃病例。使用改良的时间事件模型，以年龄为时间尺度，总体上并按性别、种族、贫困程度和地理位置进行分层，估计 80 岁时的斑秃终生发病率。在斑秃诊断后 2 年内，与匹配的未受影响的对照组相比，评估了心理健康、医疗保健利用和与工作相关的结局，并按上述相同的社会人口亚组进行分层。

结果

在研究期间，有 6961 人患上了斑秃。斑秃的终生发病率总体为 2.11%（95%置信区间 [CI] 2.06-2.16）。女性的终生发病率（2.35%，95%CI 2.28-2.43）高于男性（1.88%，95%CI 1.81-1.94）。亚裔（5.87%，95%CI 5.51-6.24）、其他（4.5%，95%CI 3.63-5.31）、混血（4.4%，95%CI 3.50-5.37）和黑人（3.0%，95%CI 2.63-3.42）的终生发病率高于白人（1.7%，95%CI 1.68-1.80）。在社会人口学亚组中，最贫困的五分位数（最贫困五分位数：2.92%，95%CI 2.77-3.07）的终生发病率最高，而最不贫困的五分位数（1.68%，95%CI 1.59-1.78）则最低。在所有社会人口亚组中，黑人斑秃患者最有可能出现焦虑（与匹配对照组相比，调整后的优势比为 2.92，95%CI 1.71-4.91），且缺勤时间最长（与匹配对照组相比，调整后的风险比为 2.54，95%CI 1.80-3.56）。