Young Adults Face Highest Burden of Alopecia Areata, Global Study Finds

A comprehensive new global analysis reveals that while rates of alopecia areata (AA) have modestly declined over the past 3 decades, high-income countries continue to shoulder a disproportionate share of the disease burden, particularly among young adults.¹

The authors emphasized that the findings underscore the need for targeted public health strategies, particularly those addressing young women and individuals in their early 30s. They also called for improved surveillance systems and equitable access to treatment globally.

As therapeutic options expand, including newer biologic treatments, understanding the evolving global landscape of alopecia areata will be essential for guiding prevention efforts and healthcare resource allocation in the years ahead.

Publishing their findings in Annals of Dermatology, the researchers analyzed data from the Global Burden of Disease (GBD) 2021 database to examine trends in alopecia areata among individuals aged 15 to 49 across 204 countries and territories between 1990 and 2021.

Researchers found that global age-standardized incidence rates (ASIR) declined from 577.59 cases per 100,000 people in 1990 to 519.34 per 100,000 in 2021. Similarly, age-standardized disability-adjusted life year (DALY) rates fell from 10.73 to 9.68 per 100,000 during the same period. These trends reflect estimated annual percentage decreases of −0.20 for incidence and −0.19 for DALYs, signaling steady but modest progress.

Despite these improvements, the burden remained substantial and unevenly distributed.

High-income regions recorded the highest disease rates in 2021. High-Socio-demographic Index (SDI) countries reported an ASIR of 631.39 per 100,000 and a DALY rate of 11.75 per 100,000, significantly higher than low-SDI regions. North America had the highest regional burden overall, with incidence reaching 744.72 per 100,000 and DALY rates at 13.76 per 100,000. In contrast, North Africa and the Middle East showed some of the lowest rates globally.

One of the study’s most notable findings was the strong positive correlation between socioeconomic development and AA burden. Higher SDI levels were significantly associated with higher incidence and disability rates, with correlation coefficients of 0.68 for ASIR and 0.72 for DALYs.

“The elevated AA prevalence in high-income regions (e.g., North America, Australasia) likely reflects improved diagnostic capabilities and therapeutic access, with biologic treatment availability correlating strongly with case identification rates (β = 0.65; 95% CI, 0.58-0.72),” explained the researchers.

The group added that the higher burden seen in low-income regions may be a result of environmental stressors, such as particulate matter exposure levels.

The analysis also revealed that age played a significant role. Disease burden peaked among individuals aged 30 to 34, with incidence reaching 642.3 cases per 100,000 and DALYs at 12.1 per 100,000. Rates were lowest among adolescents aged 15 to 19, with an incidence of 382.4 cases per 100,000 and DALYs at 7.2 per 100,000.

“The peak AA incidence in 30–34-year-olds may reflect critical psychosocial transitions, as this cohort faces simultaneous professional (career advancement pressures), familial (marital/childbearing expectations), and socioeconomic stressors that elevate allostatic load by 34% (95% CI, 28% to 40%) compared to younger adults,” noted the researchers of this finding.

Women experienced approximately 1.4 times higher incidence rates and 1.5 times greater DALY burden compared to men. The group suggested that hormonal influences, immune system differences, and healthcare-seeking behaviors may help explain this disparity.

A US-focused cohort study published in 2023 showed similar trends, with a higher AA incidence observed among women (range, 108.53-118.56) vs men (range, 63.68-72.09) and adults (range, 95.45-102.63) vs children (range, 56.08-60.05).²

From the new global study, researchers determined that most regions saw declining or stable trends, a few stood out for increasing burden. East Asia recorded a slight but significant rise in both incidence and DALY rates over the study period. At the national level, Oman experienced the fastest increase in incidence, while Guatemala showed the steepest rise in DALY burden. Researchers noted that these increases may reflect a combination of improved detection, environmental stressors, and shifting lifestyle factors.

References

1. Ma Y, Zhang Y, Dong S, Mu Y. The evolving global burden of alopecia areata in young adults: high-income nations bear the greatest impact. Ann Dermatol. 2025;38(1):59-68. doi:10.5021/ad.25.120
2. Mostaghimi A, Gao W, Ray M, et al. Trends in prevalence and incidence of alopecia areata, alopecia totalis, and alopecia universalis among adults and children in a US employer-sponsored insured population. JAMA Dermatol. 2023;159(4):411-418. doi:10.1001/jamadermatol.2023.0002