Neighborhood Socioeconomic Level Impacts Hidradenitis Suppurativa Development

Neighborhood-level socioeconomic status (nSES) is independently associated with a new hidradenitis suppurativa (HS) diagnosis in patients, according to recent findings, supporting the hypothesis that one’s ‘neighborhood-level’ may have an impact on HS development.1

These data represent the conclusion of research conducted by a team of investigators such as Aileen Y. Chang, MD, from the department of dermatology at the University of California, San Francisco School of Medicine. Chang and coauthors highlighted that there had been some research published in the US exploring neighborhood-level SES (nSES) and HS, though an effect estimate of nSES on HS development had not previously been elucidated.2

“In this study, we assessed whether nSES was associated with new HS diagnoses within a single health system using a census tract−level index measure of nSES,” Chang and colleagues wrote.1 “We hypothesized that there would be greater odds of new HS cases for dermatology patients residing in lower SES neighborhoods.”

The investigators conducted their cross-sectional study, involving patients who had been seen at dermatology clinics within the University of California, San Francisco (UCSF) health system from August 2019 - May 2024. Those deemed eligible for inclusion were also residents of the San Francisco Bay Area at the time of their first visit.

Chang et al gathered demographic details from self-reported information documented in participants’ electronic health records. They performed their data analysis between June 2024 - February 2025 and evaluated nSES via a census tract-level composite index that incorporated a variety of factors.

These factors included level of poverty, income, costs of housing and rental properties, level of participant education, employment status, and occupation type. The investigative team then placed participants into cateogories based on the distribution of nSES across counties in the Bay Area into quintiles, with quintile 5 representing the highest level of nSES.

New diagnoses of HS during the study period were identified by the investigators using ICD-10 codes and confirmed through a review of patients' medical records. Logistic regression models using generalized estimating equations were also applied by the team to account for clustering by census tract.

The primary exposure variable was nSES quintile, with quintile 5 being utilized as the reference group. Chang and colleagues determined that the binary outcome would be the presence of a new diagnosis of the skin disease, adjusting their models for potential confounding variables. In their secondary analyses, the investigators assessed variables such as obesity, smoking status, and type of health insurance as potential mediators.

The analysis included 65,766 individuals, with a mean age of 50.4 years and 41.8% identifying as female. Among these subjects, 485 were given a new HS diagnosis. After their adjustment for demographic variables, the investigators found that the odds of a new disease diagnosis were significantly greater among those residing in neighborhoods shown to have lower SES.

When compared to individuals in the highest SES quintile (Q5), it was noted that the adjusted odds ratios (ORs) for HS diagnosis were as follows:

• Q1: OR = 3.32 (95% CI, 2.46–4.49)
• Q2: OR = 2.25 (95% CI, 1.62–3.12)
• Q3: OR = 1.97 (95% CI, 1.46–2.66)
• Q4: OR = 1.44 (95% CI, 1.06–1.96)

These findings were also found to be statistically significant (P < .001).

In analyses stratified by race, it was suggested that the elevated odds of HS diagnosis among individuals in lower-SES neighborhoods were seen across racial and ethnic cohorts. However, in some groups, these associations did not attain the 5% threshold of statistical significance.

“We observed attenuation in effect size when race and ethnicity were added to the model, with the largest attenuation in the lowest-SES neighborhoods,” they wrote.1 “This supports our hypothesis that race and ethnicity function as a confounder of the relationship between nSES and a new HS diagnosis. The additional observation of a possible interaction between nSES and race and ethnicity in their effects on HS indicates that this relationship deserves further investigation.”

References

1. Chang AY, Sanchez-Anguiano ME, Supapannachart K, et al. Neighborhood Socioeconomic Status and New Hidradenitis Suppurativa Diagnoses in a Single Health System. JAMA Dermatol. Published online May 14, 2025. doi:10.1001/jamadermatol.2025.1190.

2. Vuong CL, Park HH, Zhang S, Conic RRZ, Hightower GK. Neighborhood-based analysis of adolescent hidradenitis suppurativa prevalence in a large metropolitan area. JAAD Int. 2022;9:80-81. doi:10.1016/j.jdin.2022.08.015.