Impact of demographic variables on odds of developing autoimmune alopecia

Summary: Abstract Body: Frontal fibrosing alopecia(FFA), discoid lupus erythematosus(DLE), and alopecia areata(AA) have all been associated with autoimmunity with various racial predilections. Specifically, FFA has been described as primarily affecting White women and DLE, Black women. Given the known impact of race on socioeconomic status (SES), it is unclear if race is a true driver of disease risk in patients or simply a proxy for SES. The Centers for Disease Control (CDC) has established a level of vulnerability scale (LOV) for every zip code that incorporates SES and other demographic variables to identify areas of affluence. To determine the impact of SES on disease odds, we conducted a retrospective cohort study of patient zip codes to compare LOV in 672 patients with DLE, AA, or FFA treated at Johns Hopkins Hospital over 9 years. Multivariable-adjusted logistic regression and ANOVA were performed. Odds ratios, 95% confidence intervals, and p-values were determined, with p<0.05 considered significant. The average age of patients differed across conditions: 45.48 for AA, 61.67 for FFA, 49.48 for DLE (p<0.001). Racial distribution also varied, with Whites the most commonly affected racial group with FFA (51.7%) and Blacks the most commonly affected with DLE and AA (76.0%, 51.5%, respectively; p<0.001). However, when controlled for race & age, FFA patients were nearly 2x more likely to be from affluent zip codes compared to AA patients (OR: 1.786, p=0.009). When controlling for age & SES, race had no impact on the odds of developing FFA (White vs Black p=0.204). In contrast, Black race was the strongest predictor of DLE odds when compared to AA(OR: 2.97, p<0.001), with SES having no impact (p=0.446). While race was a key driver of disease in DLE, it did not influence disease odds in FFA, suggesting its role may be overemphasized in FFA’s etiology. Instead, unique environmental exposures that have been associated with higher SES in all races, such as sunscreen use, deserve added focus. Further study is required to understand biological and environmental factors that increase diseases odds of DLE in Black patients. Jiana Wyche¹, Crystal Aguh¹ 1. Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States. Minoritized Populations and Health Disparities Research