Autoimmune, atopic, and mental health comorbid conditions associated with alopecia areata in the United States

JAMA Dermatol. 2013 Jul;149(7):789-94. doi: 10.1001/jamadermatol.2013.3049.


Objective: To evaluate the prevalence of comorbid conditions among patients with alopecia areata (AA) seen at tertiary care hospitals in Boston, Massachusetts, during an 11-year period.

Design: Retrospective cross-sectional study.

Setting: Tertiary care hospitals in Boston, including Brigham and Women's Hospital and Massachusetts General Hospital.

Participants: We identified 3568 individuals with AA seen in the Partners health care system in Boston between January 1, 2000, and January 1, 2011. We performed comprehensive searches of the Research Patient Data Repository using International Classification of Diseases, Ninth Revision code 704.01. We randomly selected 350 patients and manually reviewed their medical records to train and validate a novel artificial intelligence program. This program then used natural language processing to review free-text medical records and confirm a diagnosis of AA. To confirm the algorithm, we manually reviewed a subset of records and found 93.9% validity.

Main outcomes and measures: The prevalence of comorbid conditions was assessed.

Results: Common comorbid conditions included autoimmune diagnoses (thyroid disease in 14.6%, diabetes mellitus in 11.1%, inflammatory bowel disease in (2.0%) [corrected], systemic lupus erythematosus in 4.3%, rheumatoid arthritis in 3.9%, and psoriasis and psoriatic arthritis in (6.3%) [corrected], atopy (allergic rhinitis, asthma, and/or eczema in 38.2% and contact dermatitis and other eczema in 35.9%), and mental health problems (depression or anxiety in 25.5%). We also found high prevalences of hyperlipidemia (24.5%), hypertension (21.9%), and gastroesophageal reflux disease (17.3%). This profile was different from that seen in a comparison psoriasis and psoriatic arthritis group.

Conclusions and relevance: We found a high prevalence of comorbid conditions among individuals with AA presenting to academic medical centers in Boston. Physicians caring for patients with AA should consider screening for comorbid conditions.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alopecia Areata / epidemiology*
  • Anxiety / epidemiology
  • Asthma / epidemiology
  • Autoimmune Diseases / epidemiology*
  • Boston / epidemiology
  • Comorbidity
  • Depression / epidemiology
  • Dermatitis, Contact / epidemiology
  • Diabetes Mellitus / epidemiology
  • Eczema / epidemiology
  • Female
  • Gastroesophageal Reflux / epidemiology
  • Humans
  • Hyperlipidemias / epidemiology
  • Hypertension / epidemiology
  • Inflammatory Bowel Diseases / epidemiology
  • Male
  • Middle Aged
  • Prevalence
  • Retrospective Studies
  • Rhinitis / epidemiology
  • Thyroid Diseases / epidemiology
  • Young Adult