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Original Investigation
May 29, 2019

All-Cause and Cause-Specific Mortality Risks Associated With Alopecia Areata: A Korean Nationwide Population-Based Study

Author Affiliations
  • 1Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
  • 2Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
  • 3Big Data Steering, National Health Insurance Service, Wonju, Republic of Korea
JAMA Dermatol. Published online May 29, 2019. doi:10.1001/jamadermatol.2019.0629
Key Points

Question  Does mortality risk in patients with alopecia areata differ from that in the general population?

Findings  In this nationwide population-based cohort study, patients with alopecia areata had a higher mortality risk associated with intentional self-harm/psychiatric diseases than controls. Mortality risk associated with smoking-associated malignant diseases including lung cancer was also increased in patients with alopecia totalis/universalis; however, mortality risk associated with diabetes mellitus was decreased in patients with alopecia areata.

Meaning  The psychiatric burden of alopecia areata may have contributed to increased mortality associated with self-harm, psychiatric diseases, and smoking-associated malignant diseases.

Abstract

Importance  Alopecia areata is associated with diverse systemic and psychiatric diseases. However, whether all-cause and cause-specific mortality in patients with alopecia areata differs from that of the general population remains unclear.

Objective  To investigate all-cause and cause-specific mortality risk in patients with alopecia areata.

Design, Setting, and Participants  Using the National Health Insurance Service database and National Death Registry of Korea, a retrospective cohort study of participants identified in 2006, with investigation of mortality until 2016, was carried out. Patients with alopecia areata with at least 3 documented visits to a dermatologist with an International Statistical Classification of Diseases (tenth revision) code of L63 during 2002 to 2006 were included. For comparison, 1:10 age- and sex-matched controls without documented visits with a code of L63 until 2016 were included.

Exposures  Patients with alopecia areata and controls without alopecia areata.

Main Outcomes and Measures  The study population was followed from January 1, 2007, for a period of 10 years to estimate all- and cause-specific mortality.

Results  The study comprised 73 107 patients with alopecia areata and 731 070 age- and sex-matched controls. Of these, 6023 were patients with alopecia totalis/universalis. No differences in all-cause mortality risk between the cohorts were found (HR, 0.97; 95% CI, 0.87-1.09). However, mortality associated with intentional self-harm/psychiatric diseases was greater in patients than in participants in the control group (HR, 1.21; 95% CI, 1.04-1.41). Adult patients aged 35 years or younger (HR, 1.68; 95% CI, 1.32-2.12) and those with alopecia totalis/universalis (HR, 1.85; 95% CI, 1.25-2.75) were particularly affected. Mortality associated with lung cancer was greater in patients with alopecia totalis/universalis (HR, 2.16; 95% CI, 1.41-3.33). However, mortality associated with diabetes mellitus was significantly lower in patients with alopecia areata (HR, 0.53; 95% CI, 0.36-0.79).

Conclusions and Relevance  Patients with alopecia areata have a higher risk of mortality associated with self-harm, psychiatric diseases, and smoking-associated malignant diseases including lung cancer. For better outcomes, clinicians should appropriately treat patients to ensure emotional and psychological well-being.

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