Racial Disparities Shown for Delayed Diagnosis, Dermatologic Care in Hidradenitis Suppurativa

Racial disparities exist in time to diagnosis and dermatologic care for hidradenitis suppurativa (HS), with Black patients more likely to report surgery before seeing a dermatologist. Study findings were published in the Journal of the National Medical Association.

HS is a chronic inflammatory skin condition that can be debilitating, with pain and drainage leading to poor quality of life, difficulty maintaining jobs and relationships, social isolation, and stigma, noted researchers.

Although true prevalence of HS remains unknown, Black Americans have been shown to be disproportionately affected by the condition as they typically experience greater burden of disease that corresponds with mortality risk. Care-related factors may contribute to this disparity, the study authors explained, particularly regarding access as Black Americans are less than half as likely to visit a dermatologist and make approximately one-third as many annual visits to dermatology per capita in the United States compared with Whites.

“Dermatologists are the specialists most likely to effectively diagnose and manage HS with medical therapies, though access and wait times are barriers to receiving appropriate care. Patients with a longer delay in diagnosis often present to multiple specialists and primary care providers before seeing a dermatologist or receiving a diagnosis from another provider,” they noted.

Seeking to further investigate delay in diagnosis and specialist care for HS by race, researchers conducted a retrospective chart review of patients with 3 or more encounters for HS at an urban Midwestern Academic Center between January 1, 2002, and March 19, 2019.

A total of 953 patients were included in the statistical analysis, with data collected on race, ethnicity, gender, date of HS symptom onset, date of HS diagnosis, age at HS diagnosis, insurer at diagnosis, tobacco use, whether a patient had been seen by a dermatologist for HS, time from HS presentation to the first dermatology visit for HS, and other specialists seen for HS before dermatology.

“A negative binomial model was used to model the years of delay in diagnosis, which was computed as the difference between the year of symptom onset and the year of diagnosis as an integer number. Race/ethnicity, gender, current insurance carrier, and tobacco use were used as predictors,” explained researchers.

Among the study cohort overall, mean (SD) age at diagnosis was 35.5 (13.2) years and mean delay in diagnosis was 4.1 (7.0) years. By race, mean age at diagnosis for White patients was 37.7 (13.7) years, Black patients was 33.9 (12.5) years, Hispanic patients was 34.6 (14.4), and all other races were 32.3 (12.8) years (P = .004).

Findings showed disparities regarding delay in diagnosis. White patients reported shorter delays in diagnosis (3.2 [6.3] years) compared with Black patients (4.8 [7.0] years), Hispanic patients (4.7 [5.8] years), and other races (4.9 [7.4] years) (P < .001). When adjusting for insurer and tobacco use, Black patients reported delays in diagnosis 1.62 times greater than that for White patients (P = .0013). The other racial/ethnic groups had similarly large, but not statistically significant increases.

Moreover, of the 932 patients with known specialist visit types, 500 (53.6%) had seen a dermatologist, including 222 (47.8%) of Black patients, 242 (59.5%) of White patients, 24 (64.9%) of Hispanic patients, and 12 (50%) patients of other races (P = .003). White patients and Hispanic patients saw a dermatologist an average of 3.0 years after the first presentation of HS and Black patients saw a dermatologist on average 5.0 years after first presentation (P = .004).

Of the patients who did see a dermatologist, 44.9% of Black patients, 31.6% of White patients, 23.1% of Hispanic patients, and 30.8% of other races saw surgery before dermatology (P < .001).

“Our data, while limited to a single academic center, indicate that non-White patients have a longer delay in diagnosis than their White counterparts and that Black patients do not see dermatology as early in their disease course as other racial groups,” concluded researchers.

“Black patients also see surgery more often than White patients before seeing dermatology, which could suggest greater disease severity at presentation and diagnosis or difficult access to dermatology.”

Reference

Serrano L, Ulschmid C, Szabo A, Roth G, Sokumbi O. Racial disparities of delay in diagnosis and dermatologic care for hidradenitis suppurativa. J Natl Med Assoc. Published online October 28, 2022. doi:10.1016/j.jnma.2022.08.002