Hidradenitis Suppurativa Disproportionately Affects Black, Female Patients

Hidradenitis suppurativa (HS) disproportionately affects Black patients, females, tobacco smokers, public insurance holders, and those with disabilities, according to a poster presented at the Skin of Color Update on September 13.¹

HS is a skin condition that causes painful lumps deep in the skin, usually developing where skin touches skin, like the inner thighs, armpits, and groin.² Patients may live with intense pain as many go undiagnosed for years, which can cause trouble sitting, walking, or reaching for things depending on where the lumps develop.

Recent literature suggested that the prevalence of HS is underestimated in the US.¹ Similarly, there are insufficient studies describing the sociodemographic characteristics and comorbidities of US patients with HS. In light of this gap, the researchers aimed to determine whether HS diagnoses differ by sociodemographic characteristics or comorbidity status.

Hidradenitis suppurativa (HS) disproportionately affects Black patients, women, smokers, and those with public insurance or disabilities. | Image Credit: Vitalii Vodolazskyi - stock.adobe.com

Consequently, the researchers conducted a cross-sectional analysis of the All of Us (AoU) Research Program, a National Institutes of Health initiative dedicated to enrolling underrepresented populations in biomedical research. This program helps to connect patients with relevant clinical studies and to discover which treatments work best for those of diverse backgrounds.³

They identified HS cases in the AoU database through relevant International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and Systematized Nomenclature of Medicine (SNOMED) codes.¹ Also, the researchers extracted patient characteristics and demographic information from electronic health records (EHRs) and survey data. Next, they analyzed ORs of HS diagnoses by multivariate logistic regression, adjusting for sociodemographic characteristics and tobacco smoking habits.

Of the 407,333 adult patients enrolled in the AoU database between May 2017 and June 2022, EHR data was available for 266,612 (65.5%) of them. Among these patients, 1631 (0.6%) had an HS diagnosis, which equated to an overall HS prevalence of 0.61%.

The researchers reported that most patients diagnosed with HS were White (40.2%; n = 655), female (80.1%; n = 1307), and younger than 65 years old (84.2%; n = 1374). Additionally, common comorbidities among this population included obesity (68.8%; n = 1222), hypertension (60.1%; n = 981), and major depressive disorder (49.2%; n = 803).

They found that female patients (OR, 2.74; 95% CI, 2.41-3.11) had increased odds of an HS diagnosis, along with Black (or, 2.62; 95% CI, 2.34-2.92), Hispanic (OR, 1.24; 95% CI, 1.07-1.42), and “other” non-White (OR, 1.22; 95% CI, 1.08-1.38) patients. Similarly, those with public insurance (OR, 1.48; 95% CI, 1.13-1.96), lower educational attainment (OR, 1.45; 95% CI, 1.20-1.75), and an annual household income of less than $35,000 (OR, 2.11; 95% CI, 1.89-2.36) had higher odds of receiving an HS diagnosis.

Patients aged 65 and older had decreased odds of an HS diagnosis (OR, 0.31; 95% CI, 0.27-0.35). Lastly, those with HS were more likely to smoke tobacco (OR, 2.72; 95% CI, 2.43-3.05) and have a disability (OR, 1.44; 95% CI, 1.29-1.69).

“After adjusting for confounders, patients who are Black, female, smoke tobacco, have disabilities, public insurance, or a lower socioeconomic status were more likely to have an HS diagnosis than those in the AoU database who did not have an HS diagnosis,” Noelle Desir, MD candidate at Weill Cornell Medical College and one of the study's authors, said in an on-site interview with The American Journal of Managed Care^®.

Looking ahead, the researchers emphasized the need for additional population-based studies to more accurately assess HS prevalence in the US and better understand patient demographics and related comorbidities.

“A better understanding of the sociodemographics of this condition enables dermatologists to provide targeted education to at-risk populations, allowing for earlier diagnosis and treatment of this potentially debilitating condition,” the authors wrote.

References

1. Desir N, Encarnacion IN, Ogunleye T, Taylor S. Hidradenitis suppurativa disproportionately affects Black, female patients: a cross-sectional study of the All of Us Research Program. Presented at: Skin of Color Update 2024; September 13-15, 2024; New York, NY.
2. Hidradenitis suppurativa: overview. American Academy of Dermatology Association. Updated May 3, 2022. Accessed September 24, 2024. https://www.aad.org/public/diseases/a-z/hidradenitis-suppurativa-overview
3. All of Us research program overview. National Institutes of Health. Reviewed October 18, 2023. Accessed September 24, 2024. https://allofus.nih.gov/about/program-overview