Racial and Ethnic Differences in the Burden of Alopecia Areata in Contemporary Pediatric Practice

In this retrospective, cross-sectional study, we evaluated racial and ethnic variation in alopecia areata prevalence among children aged 5-17 years who received routine pediatric care during 2017-2019 in a large integrated healthcare delivery system in Northern California. Among 598,067 children (mean age 11.0 ± 3.7 years; 49.1% female; 34.0% non-Hispanic White, 8.8% Black, 27.4% Hispanic, and 21.9% Asian/Pacific Islander), the age-sex-adjusted prevalence of alopecia areata (per 100,000) was higher for Hispanic (298 [95% confidence interval 272-326]), Asian/Pacific Islander (279 [251-310]), and Black (276 [233-325]) children and lower for non-Hispanic White (119 [104-135]) children; among Asian/Pacific Islander subgroups, prevalence ranged from 454 [330-616] South Asian, 333 [261-419] Filipino, 318 [177-550] Vietnamese, 310 [183-495] Native Hawaiian/Pacific Islander, and 178 [119-256] Chinese. Compared to non-Hispanic White children, the age-sex-adjusted prevalence ratios for alopecia areata were two- to three-fold higher for South Asian (3.33 [2.46-4.52]), Filipino (2.80 [2.15-3.64]), Vietnamese (2.73 [1.65-4.52]), Native Hawaiian/Pacific Islander (2.62 [1.62-4.23]), Hispanic (2.49 [2.14-2.91]), and Black (2.32 [1.89-2.85]) children and only somewhat higher for Chinese children (1.49 [1.01-2.19]). This large US population study identified a substantial burden of alopecia areata among Black, Hispanic, and disaggregated US Asian and Pacific Islander children, particularly South Asian, Filipino, Vietnamese, and Native Hawaiian/Pacific Islander subgroups.