The epidemiology of alopecia areata: a population-based cohort study in UK primary care

Abstract

Background: There is a lack of population-based information on the disease burden and management of alopecia areata (AA).

Objectives: To describe the epidemiology of AA, focusing on incidence, demographics and patterns of healthcare utilization.

Methods: Population-based cohort study of 4·16 million adults and children, using UK electronic primary care records from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network database, 2009-2018. The incidence and point prevalence of AA were estimated. Variation in AA incidence by age, sex, deprivation, geographical distribution and ethnicity was examined. Patterns of healthcare utilization were evaluated in people with incident AA.

Results: The AA incidence rate was 0·26 per 1000 person-years. AA point prevalence in 2018 was 0·58% in adults. AA onset peaked at age 25-29 years for both sexes, although the peak was broader in females. People of nonwhite ethnicity were more likely to present with AA, especially those of Asian ethnicity [incidence rate ratio (IRR) 3·32 (95% confidence interval 3·11-3·55)]. Higher AA incidence was associated with social deprivation [IRR most vs. least deprived quintile 1·47 (1·37-1·59)] and urban living [IRR 1·23 (1·14-1·32)]. People of higher social deprivation were less likely to be referred for specialist dermatology review.

Conclusions: By providing the first large-scale estimates of the incidence and point prevalence of AA, our study helps to understand the burden of AA on the population. Understanding the variation in AA onset between different population groups may give insight into the pathogenesis of AA and its management.

Figure 1

The incidence rates of AA by age at diagnosis and sex. Data are unadjusted incidence rates per 1000 person‐years for 2009–2018 inclusive in a total population of 4 163 162 people. Grey shading represents 95% confidence intervals. AA, alopecia areata.

Figure 2

The geographic distribution of alopecia areata by region in England. Data are adjusted incidence rate ratios, relative to the London region, with adjustment for sex, ethnicity, Index of Multiple Deprivation quintile, geographic region and geographic area (urban/rural location). Estimates are for 2009–2018 inclusive in 4 078 143 people with a postcode mapped to an English region. [Correction added after first publication 7 March 2022: Figure 2 has been corrected.]

Figure 3

Proportion of people with alopecia areata (AA) referred for specialist dermatology review within 1 year of diagnosis, by calendar year. Data are for 6187 people with AA (2018 data are not reported due to insufficient follow‐up time after AA diagnosis). Grey shading represents 95% confidence intervals.