Solam Lee1,2, Young Bin Lee1, Beom Jun Kim1, Sejin Bae3, Won-Soo Lee1. 1. Department of Dermatology and Institute of Hair and Cosmetic Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea. 2. Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea. 3. Big Data Steering, National Health Insurance Service, Wonju, Republic of Korea.
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.
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.
Authors: Chungsoo Kim; Seng Chan You; Jenna M Reps; Jae Youn Cheong; Rae Woong Park Journal: J Am Med Inform Assoc Date: 2021-06-12 Impact factor: 4.497
Authors: Jonathan Lavian; Sara Jiayang Li; Eunice Yoojin Lee; Lindsey A Bordone; Fernanda C G Polubriaginof; Angela M Christiano; Arash Mostaghimi Journal: Int J Trichology Date: 2020-11-03