JAMA Dermatology

<jats:sec id="ab-doi250016-4"><jats:title>Importance</jats:title><jats:p>Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition. Risk factors for developing HS (eg smoking and obesity) are influenced by social drivers of health at the neighborhood level. However, the association of neighborhood-level socioeconomic status (nSES) and HS has not been adequately assessed.</jats:p></jats:sec><jats:sec id="ab-doi250016-5"><jats:title>Objective</jats:title><jats:p>To evaluate the association of nSES with new HS diagnoses among dermatology patients within a single health system.</jats:p></jats:sec><jats:sec id="ab-doi250016-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This was a cross-sectional study of patients of the dermatology clinics at the University of California San Francisco health system between August 1, 2019, and May 31, 2024, who were also residents of the San Francisco Bay Area at index visit. Data analyses were performed from June 1, 2024, to February 11, 2025.</jats:p></jats:sec><jats:sec id="ab-doi250016-7"><jats:title>Exposure</jats:title><jats:p>Census tract-level index measure of nSES that incorporated income, poverty, housing cost, rental cost, education, occupation, and employment. Quintiles of nSES were assigned based on nSES distribution in the San Francisco Bay Area counties.</jats:p></jats:sec><jats:sec id="ab-doi250016-8"><jats:title>Main Outcomes and Measures</jats:title><jats:p>A new HS diagnosis during the study period, identified by the <jats:italic>International Statistical Classification of Diseases and Related Health Problems, Tenth Revision </jats:italic>code, and confirmed by medical record review. Logistic regression models were constructed and fit by generalized estimating equations accounting for clustering by census tract with nSES quintile as the primary exposure (reference used was quintile 5, the highest nSES quintile); new HS diagnosis as the binary outcome; and age, sex, and race and ethnicity as confounders. In secondary analyses, smoking status, obesity, and health insurance type were assessed as possible mediators.</jats:p></jats:sec><jats:sec id="ab-doi250016-9"><jats:title>Results</jats:title><jats:p>The analyses included a total of 65 766 patients (mean [SD] age, 50.4 [18.3] years; 41.8% female), of whom 485 (0.7%) had a new HS diagnosis. Greater odds of a new HS diagnosis were observed in lower-SES neighborhoods (Q1-Q4)—after adjusting for age, sex, and race and ethnicity, odds ratio for Q1 was 3.32 (95% CI, 2.46-4.49); Q2, 2.25 (95% CI, 1.62-3.12); Q3, 1.97 (95% CI, 1.46-2.66); and Q4, 1.44 (95% CI, 1.06-1.96) (<jats:italic>P</jats:italic> &amp;amp;lt;.001 [linear trend]). In race-stratified analyses, greater odds of a new HS diagnosis were observed among patients residing in lower-SES neighborhoods, although this pattern did not reach statistical significance at the 5% level in all racial and ethnic groups.</jats:p></jats:sec><jats:sec id="ab-doi250016-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>This cross-sectional study found that nSES was independently associated with a new diagnosis of HS among dermatology patients. This finding supports the hypothesis that neighborhood-level factors may influence the development of HS.</jats:p></jats:sec>

Prevalence of hidradenitis suppurativa: a systematic review and meta-regression analysis.

JAMA Dermatol

Sex- and age-adjusted population analysis of prevalence estimates for hidradenitis suppurativa in the United States.

Incidence of hidradenitis suppurativa in the United States: a sex- and age-adjusted population analysis.

J Am Acad Dermatol

Hidradenitis suppurativa in patients of color is associated with increased disease severity and healthcare utilization: a retrospective analysis of 2 U.S. cohorts.

JAAD Int

African American patients with hidradenitis suppurativa have significant health care disparities: a retrospective study.

J Cutan Med Surg

Hidradenitis suppurativa (HS) is associated with low socioeconomic status (SES): a cross-sectional reference study.

Association of low socioeconomic status with hidradenitis suppurativa in the United States.

Characterizing inpatient hospitalizations for hidradenitis suppurativa in the United States.

Hidradenitis suppurativa and social disadvantage: a nationwide administrative data study of the French hospitalized population.

J Eur Acad Dermatol Venereol

New insights in hidradenitis suppurativa from a population-based Dutch cohort: prevalence, smoking behaviour, socioeconomic status and comorbidities.

Br J Dermatol

Impact of hidradenitis suppurativa on work productivity and associated risk factors.

Impact of hidradenitis suppurativa on work loss, indirect costs and income.

Neighborhood-based analysis of adolescent hidradenitis suppurativa prevalence in a large metropolitan area.

Neighborhood socioeconomic status predictors of physical activity through young to middle adulthood: the CARDIA study.

Soc Sci Med

Change in neighborhood disadvantage and change in smoking behaviors in adults: a longitudinal, within-individual Study.

Epidemiology

Socioeconomic status and perceptions of access and safety for physical activity.

Ann Behav Med

Hidradenitis suppurativa.

Nat Rev Dis Primers

Hidradenitis suppurativa and smoking: a systematic review and meta-analysis.

Smoking cessation and risk of hidradenitis suppurativa development.

Bariatric surgery reduces the incidence of hidradenitis suppurativa in individuals with obesity: results of a nationwide administrative data study in France.

Surg Obes Relat Dis

Association between obesity and hidradenitis suppurativa among children and adolescents: a population-based analysis in the United States.

A systematic review of neighborhood disparities in point-of-sale tobacco marketing.

Am J Public Health

Neighborhood disparities in access to healthy foods and their effects on environmental justice.

Higher walkability associated with increased physical activity and reduced obesity among United States adults.

Obesity (Silver Spring)

Crime, perceived safety, and physical activity: a meta-analysis.

Prev Med

The California Neighborhoods Data System: a new resource for examining the impact of neighborhood characteristics on cancer incidence and outcomes in populations.

Cancer Causes Control

Socioeconomic status and breast cancer incidence in California for different race/ethnic groups.

Race and genetic ancestry in medicine: a time for reckoning with racism.

N Engl J Med

Evaluating patients’ unmet needs in hidradenitis suppurativa: results from the Global Survey of Impact and Healthcare Needs (VOICE) Project.

Medicare, Medicaid, and access to dermatologists: the effect of patient insurance on appointment access and wait times.

Insurance acceptance, appointment wait time, and dermatologist access across practice types in the US.

Estimating predicted probabilities from logistic regression: different methods correspond to different target populations.

Int J Epidemiol

Interventional effects for mediation analysis with multiple mediators.

Ethnic group differences in obesity in Asian Americans in California, 2013-2014.

BMC Public Health

Heterogeneity in obesity prevalence among Asian American adults.

Ann Intern Med

Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.

Lancet

Hidradenitis suppurativa and 1-carbon metabolism: role of gut microbiome, matrix metalloproteinases, and hyperhomocysteinemia.

Front Immunol

Racial/ethnic discrimination and cardiometabolic diseases: a systematic review.

J Racial Ethn Health Disparities

Associations between neighborhood-level racial residential segregation, socioeconomic factors, and life expectancy in the US.

JAMA Health Forum

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition. Risk factors for developing HS (eg smoking and obesity) are influenced by social drivers of health at the neighborhood level. However, the association of neighborhood-level socioeconomic status (nSES) and HS has not been adequately assessed.
To evaluate the association of nSES with new HS diagnoses among dermatology patients within a single health system.
This was a cross-sectional study of patients of the dermatology clinics at the University of California San Francisco health system between August 1, 2019, and May 31, 2024, who were also residents of the San Francisco Bay Area at index visit. Data analyses were performed from June 1, 2024, to February 11, 2025.
Census tract-level index measure of nSES that incorporated income, poverty, housing cost, rental cost, education, occupation, and employment. Quintiles of nSES were assigned based on nSES distribution in the San Francisco Bay Area counties.
A new HS diagnosis during the study period, identified by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code, and confirmed by medical record review. Logistic regression models were constructed and fit by generalized estimating equations accounting for clustering by census tract with nSES quintile as the primary exposure (reference used was quintile 5, the highest nSES quintile); new HS diagnosis as the binary outcome; and age, sex, and race and ethnicity as confounders. In secondary analyses, smoking status, obesity, and health insurance type were assessed as possible mediators.
The analyses included a total of 65 766 patients (mean [SD] age, 50.4 [18.3] years; 41.8% female), of whom 485 (0.7%) had a new HS diagnosis. Greater odds of a new HS diagnosis were observed in lower-SES neighborhoods (Q1-Q4)-after adjusting for age, sex, and race and ethnicity, odds ratio for Q1 was 3.32 (95% CI, 2.46-4.49); Q2, 2.25 (95% CI, 1.62-3.12); Q3, 1.97 (95% CI, 1.46-2.66); and Q4, 1.44 (95% CI, 1.06-1.96) (P <.001 [linear trend]). In race-stratified analyses, greater odds of a new HS diagnosis were observed among patients residing in lower-SES neighborhoods, although this pattern did not reach statistical significance at the 5% level in all racial and ethnic groups.
This cross-sectional study found that nSES was independently associated with a new diagnosis of HS among dermatology patients. This finding supports the hypothesis that neighborhood-level factors may influence the development of HS.

Neighborhood Socioeconomic Status and New Hidradenitis Suppurativa Diagnoses in a Single Health System.

Neighborhood Socioeconomic Status and New Hidradenitis Suppurativa Diagnoses in a Single Health System

Neighborhood Socioeconomic Status and New Hidradenitis Suppurativa Diagnoses in a Single Health System

Clinical Summary

What was studied

Key findings

Study limitations

Clinical implications

Related Questions