A new study sheds light on the complex relationship between comorbidities, social determinants of health, and hidradenitis suppurativa (HS), a chronic inflammatory skin condition. The research addresses the underrepresentation of certain populations in previous HS studies, with a particular focus on marginalized groups.
Using data from the All of Us Research Program and the Hidradenitis Suppurativa Foundations in the U.S. and Canada, the study explores how factors such as race, socioeconomic status, and psychosocial factors contribute to the severity and prevalence of HS. The findings underscore significant disparities in both the diagnosis and impact of HS among underrepresented communities.
HS, characterized by painful skin lesions such as abscesses, deep-seated nodules, and fibrotic scars, affects an estimated 1% to 4% of the population, though this figure is likely underestimated due to misdiagnosis and underreporting. Alongside its physical symptoms, HS is known for its profound psychosocial toll, given the pain, odor, drainage, and disfigurement associated with the condition.
While the exact causes of HS are still being studied, factors such as genetics, environmental influences, and behaviors play key roles. According to the study’s authors, HS disproportionately affects patients with skin of color, yet these populations are often underrepresented in HS research. “HS presents a considerable challenge due to its high comorbidity burden and its disproportionate impact on marginalized communities,” said Katie Roster, a dermatology research fellow at Massachusetts General Hospital and MD candidate at New York Medical College.
Key Findings
The study analyzed electronic health records from 319,098 patients, identifying 1,802 individuals diagnosed with HS. Among these, the majority were Black/African American (51%), followed closely by White (48%) and Asian (4.4%) patients. The findings revealed several important trends, including a higher prevalence of HS in Black/African American individuals compared to White individuals, with Black patients being 2.68 times more likely to be diagnosed (P <.001).
Further analysis showed that patients with HS were more likely to suffer from additional comorbidities. The study found a significant association between HS and conditions such as psoriasis (OR, 1.75), obstructive sleep apnea (OR, 1.18), depression (OR, 1.47), anxiety (OR, 1.63), tobacco use (OR, 2.31), and hypertension (OR, 1.15). These results suggest that HS patients may require comprehensive care addressing not only their skin condition but also associated health risks.
One surprising finding was the high prevalence of obstructive sleep apnea in HS patients, a condition traditionally less associated with HS. The study’s authors suggest that obesity, which is more common among those with HS, may contribute to this increased prevalence.
Implications and Limitations
The study’s findings highlight the importance of considering social determinants of health, such as socioeconomic status and access to care, when assessing HS. The psychosocial impact of the condition, particularly among underrepresented groups, calls for greater focus on these populations in future research and clinical care.
However, the study also has several limitations, including its retrospective, cross-sectional design, which prevents the establishment of causality. Additionally, the lack of HS staging data meant the researchers could not explore the relationship between the severity of HS and the comorbidities identified.
In conclusion, the study emphasizes the need for more inclusive research and a broader understanding of the factors that influence HS outcomes, particularly in marginalized communities. “These findings emphasize the interplay between social determinants of health and HS, highlighting the psychosocial implications among underrepresented groups,” the authors concluded.
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