Study Reveals Significant Variations in Risk Factors and Comorbidities Among Patients with Hidradenitis Suppurativa
A recent study published in the Journal of the American Academy of Dermatology highlights significant differences in the demographics, risk factors, and comorbid conditions of patients with hidradenitis suppurativa (HS) based on race, ethnicity, and sex. The findings suggest that these factors should be carefully considered in future clinical studies of the condition.
The study, conducted at a single center in Detroit, Michigan, between 1995 and 2022, analyzed data from 13,130 HS patients. Researchers collected a range of data, including self-reported race/ethnicity, age, age at first diagnosis, and sex, as well as information on body mass index (BMI), smoking, alcohol consumption, and Charlson Comorbidity Index (CCI) scores over the course of several years.
Demographics and Disease Onset
The study found that the majority of HS patients were women (73.5%), with a notably higher proportion of women among Black/African American (AA) patients (75.7%) compared to White patients (72.9%). The incidence of HS peaked between 2015 and 2019. The average age at diagnosis was 37.9 years, with White patients typically diagnosed at an older age (39.4 years), followed by Black/AA patients (37.1 years) and patients of other races/ethnicities (36.2 years).
Women were diagnosed at younger ages than men across all racial/ethnic groups. This suggests a potential need for tailored approaches to diagnosis and treatment, particularly in women who tend to develop HS at an earlier age.
Obesity and Smoking Prevalence
The study also found striking differences in obesity rates among patients with available BMI data (5,826 patients). Over 64% of patients had obesity, with women being more affected than men (67.7% vs. 54.5%). Black/AA women had higher obesity rates than White women (P = 0.003), while White men had higher obesity rates than Black/AA men (P < 0.001).
Regarding smoking, data from 5,656 patients revealed that 31.2% were current smokers, with White patients more likely to report smoking compared to Black/AA patients (38.4% vs. 26.5%; P < 0.001). This suggests that smoking cessation programs may need to be tailored to different demographic groups to effectively address HS risk factors.
Comorbid Conditions and Race/Ethnicity
The study also examined the prevalence of comorbidities among patients with HS, finding significant differences based on race/ethnicity. Black/AA patients were less likely than White patients to have myocardial infarction (heart attack) or peripheral vascular disease, but they were more likely to suffer from chronic pulmonary disease and renal disease. After adjusting for other variables, Black/AA patients showed significantly higher odds of the following conditions:
- Congestive heart failure (OR, 2.10; P < 0.05)
- Chronic pulmonary disease (OR, 1.34; P < 0.05)
- Diabetes with complications (OR, 1.73; P < 0.05)
- Renal disease (OR, 2.66; P < 0.05)
- CCI scores of 4 or greater (OR, 1.67; P < 0.05)
These findings suggest a need for targeted screening and management of these comorbid conditions, particularly in Black/AA patients with HS.
Gender Differences in Comorbidities
Gender also played a significant role in the prevalence of comorbid conditions. Men with HS were more likely than women to experience conditions such as myocardial infarction (OR, 2.45; P < 0.05), congestive heart failure (OR, 2.21; P < 0.05), peripheral vascular disease (OR, 2.17; P < 0.05), mild liver disease (OR, 2.87; P < 0.05), and renal disease (OR, 3.05; P < 0.05). However, men were less likely to suffer from rheumatic disease (OR, 0.39; P < 0.05). These findings indicate that men with HS may face a unique set of health challenges compared to women, necessitating gender-specific management strategies.
Study Limitations and Future Directions
While the study provides valuable insights into the clinical characteristics of HS, it does have limitations. The researchers note that changes in diagnostic practices over time and unaccounted-for confounding factors could influence the findings. Additionally, the study’s results may not be fully generalizable to other populations, as it was conducted at a single medical center.
The authors concluded that the findings underscore the need for future studies to account for demographic factors such as race, ethnicity, and sex when investigating HS. Tailored clinical study designs could help uncover further nuances in the pathophysiology and management of HS across diverse patient populations.
In summary, the study highlights how race, ethnicity, and sex can influence the presentation and comorbidities associated with hidradenitis suppurativa, suggesting that a more personalized approach to treatment and management may be beneficial for patients with this challenging condition.
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