Study Describes Racial, Ethnic Disparities in Pediatric Alopecia Areata Prevalence

New research is shedding light on racial and ethnic disparities in the prevalence of alopecia areata among pediatric patients, offering novel insight into the burden among US Asian and Pacific Islander children using disaggregated data.1

Leveraging data for > 500,000 patients from Kaiser Permanente Northern California, the retrospective study found 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.1

According to the National Alopecia Areata Foundation, alopecia areata, a common autoimmune disease causing sudden hair loss on the scalp, face, and sometimes other areas of the body, affects about 1 in every 1000 children and teens.2 Growing research suggests the disease disproportionately affects certain sexes, age demographics, and races/ethnicities.

“Data from US and other cohorts suggest that persons of color, including those of Asian descent, are disproportionately affected,” Paradi Mirmirani, MD, a senior dermatologist and interim Medical Director of the Clinical Trials Program at the Permanente Medical Group, and colleagues wrote.1 “However, most studies analyzed the Asian population in aggregate, where higher alopecia areata prevalence and incidence were observed.”

To more comprehensively evaluate racial and ethnic variation in alopecia areata prevalence among pediatric patients, investigators conducted a retrospective study of children 5–17 years of age with routine pediatric exams and ≥ 12 months of Kaiser Permanente Northern California membership from 2017–2019.1

Race and ethnicity were ascertained using health record data, and alopecia areata was ascertained from outpatient encounters in pediatric, family practice, and dermatology departments based on coded diagnoses.1

In total, the cohort included 598,067 children with a mean age of 11.0 ± 3.7 years, 49.1% of whom were female. Investigators noted most (40.4%) patients were 10–14 years of age, followed by 5–9 years of age (37.2%) and 15–17 years of age (22.5%).1

Racial/ethnic groups included 34.0% non-Hispanic White (NHW), 8.8% Black, 27.4% Hispanic, 21.9% Asian/Pacific Islander (PI), and 7.9% other/unknown race. Known ethnicity for 53.6% of Asian/PI children included 23.5% Chinese, 31.4% Filipino, 18.7% South Asian, 7.2% Vietnamese, 4.6% other Southeast Asian, 8.3% Native Hawaiian/Pacific Islander (NHPI), 2.4% Japanese, 1.8% Korean, and 2.0% mixed Asian/PI.1

There were 1317 (0.2%) children with alopecia areata diagnosed between 2017 and 2019, yielding an overall alopecia areata period prevalence of 220 per 100,000 that varied modestly by sex (female 233 vs male 208).1

The age-sex-adjusted alopecia areata prevalence per 100,000 was greater for Hispanic (298), Asian/PI (279), and Black (276) compared with NHW (119) children. Among Asian/PI children, the age-sex-adjusted alopecia areata prevalence was greatest for South Asian (454) followed by Filipino (333), Vietnamese (318), and NHPI (310) children and lowest for Chinese (178) children.1

In multivariable models, investigators pointed out alopecia areata prevalence was 2–3-fold higher for South Asian (adjusted prevalence ratio [aPR], 3.33); Filipino, Vietnamese, and NHPI (aPRs, 2.6–2.8); and Hispanic and Black children (aPRs, 2.3–2.5), and modestly increased for Chinese children (aPR, 1.49) compared with NHW children.1

Of note, when Asian/PI children were examined in aggregate, investigators noted their prevalence versus NHW was attenuated (aPR, 2.34; 95% CI, 1.99–2.75), in the range of Hispanic and Black children. Among Asian/PI subgroups, South Asian children had 2.4-fold higher alopecia areata prevalence compared to Chinese children (aPR, 2.37; 95% CI, 1.50–3.75).1

“These findings underscore the higher burden among South Asian, Filipino, Vietnamese, and NHPI children,” investigators concluded.1 “Greater awareness of these differences may inform future studies of genetic susceptibilities for autoimmune disorders and potential biomarkers for AA diagnosis and treatment response.”

References

1. Dani AA, Lo JC, Darbinian JA, et al. Racial and Ethnic Differences in the Burden of Alopecia Areata in Contemporary Pediatric Practice. Pediatric Dermatology. https://doi.org/10.1111/pde.15993

2. National Alopecia Areata Foundation. Alopecia Areata in Children. Accessed June 13, 2025. https://www.naaf.org/alopecia-areata-in-children/