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Wertenteil S, Strunk A, Garg A. Association of Low Socioeconomic Status With Hidradenitis Suppurativa in the United States. JAMA Dermatol. 2018;154(9):1086–1088. doi:10.1001/jamadermatol.2018.2117
Socioeconomic status (SES) is a critical determinant of health outcome; however, no previous studies, to our knowledge, have evaluated SES among patients with hidradenitis suppurativa (HS) in the United States. Therefore we sought to determine whether HS was associated with low SES in a US population-based sample.
This cross-sectional cohort analysis used multiple health systems data that constitute the data analytics and research platform (Explorys) developed by the IBM Corporation Watson Health team. Clinical information from electronic medical records, laboratories, practice management systems, and claims systems was matched using the single set of Unified Medical Language System ontologies to create longitudinal records for unique patients. The data were standardized and curated according to common controlled vocabularies and classifications systems, including the International Classification of Diseases, SNOMED-CT (Systemized Nomenclature of Medicine–Clinical Terms), LOINC (Logical Observation Identifiers Names and Codes), and RxNorm. We compared the prevalence of low SES among patients with and without HS. The SNOMED-CT term hidradenitis was used to identify patients with HS.1 The primary outcome of interest was Medicaid insurance status, which was used as a proxy for low SES.2 The study population included adults aged 18 to 64 years with an active status in the database within the past 3 years and complete information on age, sex, race/ethnicity, and body mass index. Prevalence was compared using an adjusted odds ratio from a logistic regression model controlling for age, sex, race/ethnicity, obesity, and smoking status. This study was approved by the human subjects committee at the Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York, which waived the need for informed consent for these deidentified data.
We identified 27 615 patients with HS whose characteristics are described in the Table (24.0% men and 76.0% women). Low SES occurred among 6195 patients with HS (22.4%) compared with 898 130 of 6 633 750 patients without HS (13.5%; P < .001). Hidradenitis suppurativa was associated with low SES in the crude analysis (odds ratio, 1.85; 95% CI, 1.80-1.90). In multivariable analysis, the association was significant with only a modest effect size (odds ratio, 1.13; 95% CI, 1.09-1.16).
Patients in the United States with HS are more likely to have low SES compared with patients without HS. However, the strength of association in our analysis is highly attenuated after accounting for relevant covariates, including age, sex, obesity, tobacco smoking, and race/ethnicity.
In a Dutch cohort analysis3 that included approximately 1018 patients with HS, lower SES, as determined by zip code analysis of mean household income and real estate values, was significantly more frequent among the patients with HS compared with an age- and sex-matched reference group (46.4% vs 34.3%; P < .001). However, the primary analysis in this study did not account for important covariates such as obesity, smoking status, and race, which in the United States may be associated with HS as well as the outcome of low SES.4-6
We were unable to evaluate educational attainment or employment status within the framework of this database. We also could not determine directionality between HS and SES in this analysis. However, we speculate that the modest association of HS with low SES shown in this analysis is a consequence of the quality-of-life effects (ie, symptoms including pain and malodorous discharge) of HS, and that low SES may not be a driver for the development of HS. Nonetheless, we suggest an attentive awareness to the potential for disparate outcomes among patients with HS who have low SES.
Accepted for Publication: May 19, 2018.
Corresponding Author: Amit Garg, MD, Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, 1991 Marcus Ave, Ste 300, New Hyde Park, NY 11042 (firstname.lastname@example.org).
Published Online: August 1, 2018. doi:10.1001/jamadermatol.2018.2117
Author Contributions: Mr Strunk and Dr Garg had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Strunk, Garg.
Acquisition, analysis, or interpretation of data: Wertenteil, Strunk.
Drafting of the manuscript: Wertenteil, Garg.
Critical revision of the manuscript for important intellectual content: Strunk, Garg.
Statistical analysis: Strunk.
Obtained funding: Garg.
Administrative, technical, or material support: Wertenteil.
Conflict of Interest Disclosures: Dr Garg reported serving as an advisor for AbbVie, Inc, Pfizer, Inc, Janssen Pharmaceuticals, Inc, and Asana Biosciences, LLC, and receiving honoraria; serving as an investigator for AbbVie, Inc, UCB, and Merck & Co; consulting for AbbVie, Inc, Pfizer, Inc, Janssen Pharmaceuticals, Inc, and Asana Biosciences, LLC; and receiving research grants from AbbVie, Inc, and Merck & Co. No other disclosures were reported.
Funding/Support: This study was supported in part by an education grant from AbbVie.
Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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