Supplementary Material for: The Relationship between Stigma and Healthcare Interaction in Alopecia Areata

Introduction: People with alopecia areata (AA) experience stigma, but little is known about how this affects healthcare interaction (HCI). We aim to explore the relationship between stigma and HCI in AA.
Methods: A cross-sectional survey of 500 members of the National Alopecia Areata Foundation was performed. Survey items related to stigma and HCI were summed and sorted into low, medium, and high tertiles. Multinomial logistic regressions were performed to control for demographic and clinical factors.
Results: Respondents (n=500) were white (80.0%), female (86.2%), and insured (96.0%), with a plurality earning over $100,000 annually (34.2%). Participants in the high-stigma subgroup were more likely to be in the low-HCI subgroup (RRR: 2.22; 95% CI: 1.31–3.76; p=0.003), in comparison to participants in the low- or moderate-stigma subgroups (RRR for both: 0.45; p<0.05). This relationship was independent of demographics and clinical characteristics. However, data are from a population with limited socioeconomic diversity and high baseline healthcare engagement.
Conclusion: People with AA who experience high stigma are less likely to interact with the healthcare system, which cannot be explained by demographics or clinical factors. Stigma and HCI may be related in a dose-dependent manner, and future investigation is needed to support access to care.