Epidemiology and Health Disparities in Hidradenitis Suppurativa

During her session, “Hidradenitis Suppurativa: Health Disparities & Special Populations,” presented at Dermatology Week 2022, Ginette A. Okoye, MD, FAAD, highlighted the epidemiology and health disparities surrounding hidradenitis suppurativa (HS).

To start, Dr Okoye took a look at the epidemiology of HS by sharing the results of a recent population-based study showing that the prevalence of HS was 0.1% in the United States. This group was primarily made up of women and was significantly prevalent in the 30- to 39-year-old age range. She added that African Americans held the highest prevalence at 2 to 3 fold compared with White patients and that they were likely to be hospitalized for HS, with the inpatient hospitalization rate increased to 60% from 1999 to 2014. Additionally, HS has been associated with low socioeconomic status (SES), obesity, and smoking.

Dr Okoye went over the impact of HS on SES/income by listing the following problems patients face:

• Slower income growth
• Lower annual income
• More absenteeism, such as:
  • Patients with HS spend 18 days absent as opposed to patients without HS spending 7 days
  • Patients have a high likelihood of taking a leave of absence with short-term and long-term disability
• Higher risk of leaving the workforce

Dr Okoye then addressed health care utilization by sharing that Black and Hispanic patients with HS have the highest utilization, including:

• Outpatient visits
• ED visits
• Inpatient hospitalization

She added that there was a greater disease severity in Black and Hispanic patients. In fact, a significant number of Hispanic patients had Hurley stage 2 and 3 disease compared with White patients. Additionally, Hispanic patients were more likely to receive tertiary care earlier than Black patients.

Dr Okoye then transitioned into the health disparities in HS. “This issue of health disparities in HS is an interesting and complex one,” she stated, “We already have an increased prevalence and severity of this disease in an already underserved and disadvantage group of patients, and so the question is why? Why does this happen?” she added.

She proceeded to point out that when it comes to disparities, they are not often linked to biological reasons; in fact, they are usually the result of social determinants of health and social issues. However, in the case of HS, there may be prevalent biological differences impacting the disease state, such as hair follicle biology and propensity for fibrosis. She emphasized that these are topics that need to be researched because it is unknown how much of an impact they have in HS.

The most important aspect in health disparities falls on the social determinants of health, which consist of the following:

• Access to healthcare, particularly dermatologic care
• Restricted formularies
• Access to healthy foods and a safe, walkable environment
• Mistrust/fear of the medical establishment due to past negative experiences with health care providers such as:
  • • • being weight-shamed
      • being told bad hygiene caused their HS

Next, Dr Okoye discussed barriers obstructing biologics and systemic immunomodulators for HS. She noted that adalimumab is the only FDA-approved option to which insurance formularies restrict patients with HS. There are no discount programs for patients with public insurance, and often there is a time-consuming process for prior authorizations (PAs) and specialty pharmacy. In fact, most PAs are for biologics; HS is the most common diagnostic requiring a PA, with 60% of patients with public insurance needing biologics. Due to this, only 62% of patients actually receive biologics.

She concluded her session by noting patient concerns surrounding treatment, including:

• Needle phobia
• Long-term adverse effects, possible infections, and cancer risk
• Lack of efficacy
• Cost
• Need for refrigeration

Finally, she stressed that the inadequate representation in clinical trials also impacts this patient population’s care.

Reference
Okoye G. Hidradenitis suppurativa: health disparities & special populations. Presented at: Dermatology Week 2022; May 11–14, 2022; Virtual.