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Worse Outcomes Seen Among Black Patients With Hidradenitis Suppurativa

Article

Black patients with hidradenitis suppurativa were more likely to experience greater disease severity, emergency department visits, hospitalizations, and surgeries than non-Hispanic White patients.

Black race may be a significant risk factor for more severe disease and worse clinical outcomes in hidradenitis suppurativa (HS), according to study findings published in International Journal of Dermatology.

As a chronic inflammatory skin disease that creates a high burden for patients and the health care system, HS incidence appears to be rising, noted the study researchers, particularly in people of color. Black patients have been shown to have an incidence and prevalence of HS that is 2 to 3 times higher than White patients, but most published HS studies have included patients of Caucasian race.

Compared with the general population and even patients with other skin diseases, including psoriasis, patients with HS have been shown to experience more emergency department (ED) visits, hospitalizations, and surgeries.

“Several factors are proposed to contribute to this difference, including higher rates of obesity and metabolic syndrome in African Americans, lower socioeconomic status, and possibly an anatomic predisposition of the apocrine glands,” said the study authors. “Despite this established disparity, there are insufficient data adequately assessing HS severity and outcomes across different racial and ethnic groups while controlling for potentially confounding factors.”

They conducted a retrospective cohort study of 1190 people seen at the Medical College of Wisconsin with 3 or more encounters for HS between January 1, 2002, and March 19, 2019, to investigate the associations of patient race and ethnicity with disease severity, ED visits, hospitalizations, and surgeries, while controlling for age, sex, body mass index, tobacco use, and insurance type.

A total of 953 patients (median patient age at the time of review, 42.7; range, 14.7-91.0; 78% female) were included for the final analysis, of which 470 were Black or African American non-Hispanic (49%), 39 Hispanic (4%), 418 White non-Hispanic (44%), and 26 other race or ethnicity (3%).

After controlling for the covariates in the multivariable analysis, Black patients were shown to be 2.8 times more likely of having Hurley stage III disease (95% CI, 1.76-4.45; P < 0.001) and to have 2.86 times the risk for experiencing an ED visit for HS (95% CI, 2.12-3.88; P < 0.001), 2.25 times the risk for experiencing a hospitalization for HS (95% CI, 1.42-3.56; P < 0.001), and 1.61 times the risk for experiencing a surgical encounter for HS (95% CI, 1.34-1.95; P < 0.001) compared with White patients.

For all investigated end points, females showed a significantly lower relative risk compared with males, whereas current and past tobacco users exhibited greater relative risks than never-users.

“Although our study supports racial disparities in HS, it does not attempt to disentangle the possible contributing causes. Effectively defining and distinguishing these causes is crucial and will require further targeted research,” concluded the study authors.

“Rigorous studies on access to and utilization of care and treatments for HS in African Americans are sorely needed, while large-scale genetic studies may be warranted to fully investigate the possibility of a genetic predisposition for severe and uncontrolled HS in African Americans.”

Reference

Ulschmid C, Serrano L, Wu R, Roth GM, Sokumbi O. African American race is a risk factor for severe hidradenitis suppurativa. Int J Dermatol. Published online October 2, 2022. doi:10.1111/ijd.16428

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