Disease Burden of Alopecia Areata Greater in Lower-Income Countries

Despite decreasing trends observed in the global burden of alopecia areata, low-income countries and ​​Western Sub-Saharan Africa regions continue to exhibit rising incidence and disability-adjusted life-years rates.

Decreasing trends in the global burden of alopecia areata (AA) have been observed except in low-income countries and ​​Western Sub-Saharan Africa regions, according to study findings published in Frontiers in Immunology.

AA affects 2% of the general population and is a significant driver of psychological disorders such as depression, anxiety, and mental health distress. Researchers noted that current data on the burden of the disease does not include comprehensive information for all countries and regions, with the latest studies to provide such metrics dating back to 2010.

Seeking to provide comprehensive and comparable information on the burden of AA, they analyzed the global, regional, and national incidence and disability-adjusted life-years (DALYs) data from the Global Burden of Disease (GBD) 2019 study in terms of counts and age-standardized rates by sex, age, and sociodemographic index (SDI) value.

Data from the 2019 GBD study included 204 countries and territories stratified by age and sex from 1990 to 2019 that were classified into 5 regions based on low, low-middle, middle, high-middle, and high SDI values, and into 21 geographical areas.

“Estimated annual percentage changes (EAPCs) were calculated to quantify temporal trends in the age-standardized rates of AA incidence and DALYs. The correlations between EAPCs in the age-standardized rates and SDI values were also analyzed,” explained researchers.

In assessing global AA data from 1990 to 2019, incidence increased 49.14% from 21,742,836.45 to 32,426,829.18, and the related number of DALYs increased from 401,682.16 to 600,570.37, an increase of 49.51%. Moreover, the global age-standardized incidence rate decreased (EAPC, −0.13; 95% CI, −0.13 to −0.12) and the age-standardized DALY rate showed a downward trend (EAPC, −0.12; 95% CI, −0.13 to −0.11).

Contrary to global trends, the largest increases in the age-standardized incidence rate and age-standardized DALY rate of AA from 1990 to 2019 were observed in countries in the low-SDI quintile (EAPC, 0.02; 95% CI, −0.01 to 0.06; EAPC, 0.04; 95% CI, 0.03 to 0.04; respectively) and Western Sub-Saharan Africa regions.

The regions with the greatest changes in the incidence of AA were Central Sub-Saharan Africa and Western Sub-Saharan Africa. The 3 countries with the largest increases in AA incidence from 1990 to 2019 were Kuwait (EAPC, 0.15), South Sudan (EAPC, 0.12), and Nigeria (EAPC, 0.11).

The age-standardized incidence rate of alopecia areata from 1990 to 2019 was higher in females than in males, as demonstrated by male-to-female ratios of 0.52 and 0.53 in 1990 and 2019, respectively.

Researchers concluded that future preventive strategies for AA should focus on low-income countries, Central Sub-Saharan Africa, Western Sub-Saharan Africa, Kuwait, South Sudan, and Nigeria.

“Focusing on these regions, especially on younger people in these regions, may be an effective strategy to reduce the global burden of AA.”


Wang H, Pan L, Wu Y. Epidemiological trends in alopecia areata at the global, regional, and national levels. Front Immunol. 2022 Jul 14;13:874677. doi:10.3389/fimmu.2022.874677

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