Chang Aileen Y, Sanchez-Anguiano Maria Elena, Supapannachart Krittin, Amerson Erin H, Naik Haley B, Shiboski Stephen, Derouen Mindy C, Yazdany Jinoos
Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco.
Department of Dermatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
JAMA Dermatol. 2025 May 14. doi: 10.1001/jamadermatol.2025.1190.
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.
DESIGN, SETTING, AND PARTICIPANTS: 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.
化脓性汗腺炎（HS）是一种慢性炎症性皮肤病。HS的危险因素（如吸烟和肥胖）受社区层面健康社会驱动因素的影响。然而，社区层面社会经济地位（nSES）与HS的关联尚未得到充分评估。
评估单一医疗系统中皮肤科患者的nSES与新诊断HS之间的关联。
设计、设置和参与者：这是一项横断面研究，研究对象为2019年8月1日至2024年5月31日期间在加利福尼亚大学旧金山分校医疗系统皮肤科诊所就诊的患者，且在首次就诊时也是旧金山湾区居民。数据分析于2024年6月1日至2025年2月11日进行。
纳入收入、贫困、住房成本、租金成本、教育、职业和就业情况的社区层面nSES指数测量值。根据旧金山湾区各县的nSES分布划分nSES五分位数。
研究期间通过《国际疾病和相关健康问题统计分类》第十次修订版代码确定并经病历审查确认的新HS诊断。构建逻辑回归模型，并通过广义估计方程拟合，以社区聚类为基础，将nSES五分位数作为主要暴露因素（参考为五分位数5，即最高nSES五分位数）；新HS诊断作为二元结局；年龄、性别、种族和族裔作为混杂因素。在二次分析中，评估吸烟状况、肥胖和医疗保险类型作为可能的中介因素。
分析共纳入65766名患者（平均[标准差]年龄，50.4[18.
