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

Key PointsQuestionDoes mortality risk in patients with alopecia areata differ from that in the general population? FindingsIn 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. MeaningThe psychiatric burden of alopecia areata may have contributed to increased mortality associated with self-harm, psychiatric diseases, and smoking-associated malignant diseases. Using the National Health Insurance Service database and National Death Registry of Korea, this cohort study investigates all-cause and cause-specific mortality to estimate risk in patients with alopecia areata compared with a control group. ImportanceAlopecia 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. ObjectiveTo investigate all-cause and cause-specific mortality risk in patients with alopecia areata. Design, Setting, and ParticipantsUsing 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. ExposuresPatients with alopecia areata and controls without alopecia areata. Main Outcomes and MeasuresThe study population was followed from January 1, 2007, for a period of 10 years to estimate all- and cause-specific mortality. ResultsThe study comprised 73107 patients with alopecia areata and 731070 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 RelevancePatients 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.