## **Supplementary Online Content**

Mostaghimi A, Soliman AM, Li C, Barqawi YK, Grada A. Immune-mediated and psychiatric comorbidities among patients newly diagnosed with alopecia areata. *JAMA Dermatol.* Published online July 31, 2024. doi:10.1001/jamadermatol.2024.2404

**eFigure.** Study Design

**eTable 1.** Diagnostic Codes for Exclusion (Incidence Analysis Only)

**eTable 2.** Demographics of Prevalence Analysis Cohort (Unmatched)

This supplementary material has been provided by the authors to give readers additional information about their work.

## eFigure. Study Design

![](https://assets.reachrx.ai/images/10.1001%E2%98%8Djamadermatol.2024.2404/_page_1_Figure_1.jpeg)

AA, alopecia areata.

| Disease condition | ICD 10-CM codes | |
|-------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--|
| Autoimmune Diseases/Immune-Mediate Inflammatory Skin Disorders | | |
| Addison's Disease | E27.1 | |
| Atopic Dermatitis | L20.x | |
| Celiac Disease | K90.0 | |
| Dermatomyositis | M33.10 | |
| Dermatomyositis | M33.1 | |
| Graves' Disease | E05.00, E05.01 | |
| Guillain Barre Syndrome | G61.0 | |
| Hashimoto Thyroiditis | E06.3 | |
| Idiopathic Thrombocytopenic Purpura | D69.3 | |
| Inflammatory Bowel Syndrome | K51.x K50.x | |
| Linear Morphea | L94.1 | |
| Multiple Sclerosis | G35.x | |
| Myasthenia Gravis | G70.0, G70.0, G70.9 | |
| Pemphigus Vulgaris | L10.0-L10.4, L10.9 | |
| | | |
| Pernicious Anemia | D51.xx | |
| Psoriasis | L40.x | |
| Rheumatic Fever | I00-I02 | |
| Rheumatoid Arthritis | M06.9 | |
| Scleroderma | M34.x | |
| Sjogren's Syndrome | M35.xx | |
| Systemic Lupus Erythematosus | M32.xx | |
| Type 1 DM | E10.x | |
| Uveitis | H20.9 | |
| Psychiatric Disorders | | |
| Adjustment Disorder | F43.2x | |
| Agoraphobia | F40.00, F40.01, F40.02 | |
| Alcohol Abuse and Dependence | F10.1x, F10.12x, F10.13x, F10.15x, F10.18x, F10.2x, F10.22x, F10.23x, F10.24, F10.25x, F10.28x | |
| Anxiety | F41.1, F41.3, F41.8, F41.9 | |
| Bipolar Disorders | F31.xx | |
| Depression | F32.xx (F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.8, F32.81, F32.89, F32.9) | |
| Dysthymic Disorder | F34.1 | |
| Eating Disorders | F50.0, F50.00, F50.01, F50.02, F50.2, F50.8, F50.81, F50.82, F50.89, F50.9 | |
| Obsessive Compulsive Disorder | F42.2, F42.3, F42.4F42.8, F42.9 | |
| Panic Disorder | F41.0 | |
| Personality Disorder | F60.x | |
| Schizophrenia | F20.x, F20.8x, F20.9 | |
| Sexual Dysfunction | R37.x | |
| Sleep Disturbance | G47.x(G47.0-G47.9) | |
| Social Phobia | F40.10, F40.11 | |
| Substance Use Disorder | F11.23, F11.93, F13.230-F13.239, F13.930-F13.939, F14.23, F15.23, F15.93, F19.230-F19.239, F19.930-F19.939, F11.150, F11.250, F11.950, F12.150, F12.250, F12.950, F13.xx, F14.xx, F15.xx, F16.xx, F17.xx, F18.xx, F19.xx | |
| | | |

| eTable 1. Diagnostic Codes for Exclusion (Incidence Analysis Only) | |
|--------------------------------------------------------------------|--|
|--------------------------------------------------------------------|--|

ICD-10, International Classification of Diseases, Tenth Revision.

| | Alopecia areata N=63,384 | Control N=3,309,107 |
|----------------------------------|-----------------------------|------------------------|
| | | |
| Age at index date | | |
| Mean (SD) | 39.3 (14.0) | 39.8 (15.3) |
| Median (range) | 40 (12–64) | 42 (12–64) |
| Age groups, n (%) | | |
| 12–17 | 5311 (8.4) | 382,933 (11.6) |
| 18–29 | 11,226 (17.7) | 558,807 (16.9) |
| 30–39 | 14,536 (22.9) | 543,851 (16.4) |
| 40–49 | 14,518 (22.9) | 710,421 (21.5) |
| 50–64 | 17,793 (28.1) | 1,113,095 (33.6) |
| Sex, n (%) | | |
| Female | 39,580 (62.4) | 1,724,421 (52.1) |
| Male | 23,804 (37.6) | 1,584,686 (47.9) |
| Healthcare Plan | | |
| Encounter | 10,335 (16.3) | 478,251 (14.5) |
| Fee for service | 53,049 (83.7) | 2,830,856 (85.6) |
| Charlson Comorbidity Index | | |
| Mean (SD) | 0.18 (0.61) | 0.14 (0.56) |
| Median (range) | 0 (0–10) | 0 (0–16) |
| Region, n (%) | | |
| Midwest | 11,575 (18.8) | 723,617 (22.6) |
| Northeast | 15,121 (24.6) | 566,217 (17.7) |
| South | 23,152 (37.6) | 1,312,829 (41.0) |
| West | 11,674 (19.0) | 597,371 (18.7) |
| Healthcare Plan 1, n (%) | | |
| CDHP | 4991 (8.0) | 266,190 (8.3) |
| Comprehensive | 1460 (2.4) | 79,214 (2.5) |
| EPO | 1011 (1.6) | 40,925 (1.3) |
| HDHP | 3385 (5.5) | 182,369 (5.7) |
| HMO | 9869 (15.9) | 459,473 (14.3) |
| POS | 5349 (8.6) | 254,303 (7.9) |
| POS with capitation | 503 (0.8) | 19,997 (0.6) |
| PPO | 35,400 (57.1) | 1,917,421 (59.6) |
| Obesity* n (%) | 3173 (5.0) | 130,944 (4.0) |

**eTable 2.** Demographics of Prevalence Analysis Cohort (Unmatched)

CDHP, consumer-directed health plan; EPO, exclusive provider organization; HDHP, high deductible health plan; HMO, health maintenance organization; ICD-10, International Classification of Diseases, Tenth Revision; POS, point of service; PPO, preferred provider organization; SD, standard deviation. \*Including ICD-10 codes [E66.0x, E66.1, E66.2, E66.8, E66.9, Z68.3x, Z68.4x].

JAMA Dermatology

<jats:sec id="ab-doi240025-4"><jats:title>Importance</jats:title><jats:p>Alopecia areata (AA) has been associated with multiple comorbidities, yet information regarding the timing of comorbidity development after AA diagnosis is limited.</jats:p></jats:sec><jats:sec id="ab-doi240025-5"><jats:title>Objective</jats:title><jats:p>To evaluate the prevalence and new-onset incidence of psychiatric and autoimmune comorbidities in patients with AA in the US.</jats:p></jats:sec><jats:sec id="ab-doi240025-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This retrospective cohort analysis used data collected from January 1, 2007, to April 30, 2023, from the Merative MarketScan Research Databases, which contains medical and drug claims data from more than 46 million patients in the US. Data from adolescent and adult patients (aged 12-64 years) diagnosed with AA and patients without AA (ie, controls) were evaluated. For some analyses, patients with AA were matched (1:4) to controls based on sex, age, and geographic region.</jats:p></jats:sec><jats:sec id="ab-doi240025-7"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Prevalence (at the time of AA diagnosis) and incidence (new onset after AA diagnosis) of psychiatric and autoimmune diseases were reported as percentage of patients. Risk of developing a new-onset psychiatric or autoimmune disease after AA diagnosis was calculated as adjusted hazard ratios (AHRs) with 95% CIs.</jats:p></jats:sec><jats:sec id="ab-doi240025-8"><jats:title>Results</jats:title><jats:p>At baseline, 63 384 patients with AA and 3 309 107 without AA were identified. After matching, there were 16 512 and 66 048 patients in the AA and control groups, respectively, with a mean (SD) age of 36.9 (13.4) years and 50.6% of whom were female. Compared with the unmatched controls, patients with AA had higher prevalence of psychiatric (30.9% vs 26.8%; <jats:italic>P</jats:italic> &amp;amp;lt; .001) and autoimmune (16.1% vs 8.9%; <jats:italic>P</jats:italic> &amp;amp;lt; .0001) comorbidities at AA diagnosis; incidence was also higher in patients with AA (without history of these comorbidities) vs the matched control group. Patients with AA vs controls had a significantly higher risk of developing a psychiatric (AHR, 1.3; 95% CI, 1.3-1.4) or autoimmune (AHR, 2.7; 95% CI, 2.5-2.8) comorbidity.</jats:p></jats:sec><jats:sec id="ab-doi240025-9"><jats:title>Conclusions and Relevance</jats:title><jats:p>In this cohort study, patients with AA had a higher prevalence of autoimmune and psychiatric comorbidities at AA diagnosis and demonstrated an elevated risk of new-onset autoimmune and psychiatric comorbidities after their diagnosis. These data highlight the most common comorbidities among patients with AA and may help physicians counsel and monitor patients newly diagnosed with AA.</jats:p></jats:sec>

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Alopecia areata (AA) has been associated with multiple comorbidities, yet information regarding the timing of comorbidity development after AA diagnosis is limited.
To evaluate the prevalence and new-onset incidence of psychiatric and autoimmune comorbidities in patients with AA in the US.
This retrospective cohort analysis used data collected from January 1, 2007, to April 30, 2023, from the Merative MarketScan Research Databases, which contains medical and drug claims data from more than 46 million patients in the US. Data from adolescent and adult patients (aged 12-64 years) diagnosed with AA and patients without AA (ie, controls) were evaluated. For some analyses, patients with AA were matched (1:4) to controls based on sex, age, and geographic region.
Prevalence (at the time of AA diagnosis) and incidence (new onset after AA diagnosis) of psychiatric and autoimmune diseases were reported as percentage of patients. Risk of developing a new-onset psychiatric or autoimmune disease after AA diagnosis was calculated as adjusted hazard ratios (AHRs) with 95% CIs.
At baseline, 63 384 patients with AA and 3 309 107 without AA were identified. After matching, there were 16 512 and 66 048 patients in the AA and control groups, respectively, with a mean (SD) age of 36.9 (13.4) years and 50.6% of whom were female. Compared with the unmatched controls, patients with AA had higher prevalence of psychiatric (30.9% vs 26.8%; P < .001) and autoimmune (16.1% vs 8.9%; P < .0001) comorbidities at AA diagnosis; incidence was also higher in patients with AA (without history of these comorbidities) vs the matched control group. Patients with AA vs controls had a significantly higher risk of developing a psychiatric (AHR, 1.3; 95% CI, 1.3-1.4) or autoimmune (AHR, 2.7; 95% CI, 2.5-2.8) comorbidity.
In this cohort study, patients with AA had a higher prevalence of autoimmune and psychiatric comorbidities at AA diagnosis and demonstrated an elevated risk of new-onset autoimmune and psychiatric comorbidities after their diagnosis. These data highlight the most common comorbidities among patients with AA and may help physicians counsel and monitor patients newly diagnosed with AA.

Immune-Mediated and Psychiatric Comorbidities Among Patients Newly Diagnosed With Alopecia Areata.

Immune-Mediated and Psychiatric Comorbidities Among Patients Newly Diagnosed With Alopecia Areata

Immune-Mediated and Psychiatric Comorbidities Among Patients Newly Diagnosed With Alopecia Areata

Clinical Summary

What was studied

Key findings

Clinical implications

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