Abstract
Neighborhood factors may impact hidradenitis suppurativa (HS) severity. Neighborhood environment influences obesity and smoking, which may affect HS severity. Longer time to diagnosis is correlated with worse HS severity at diagnosis, and dermatologists are not evenly distributed geographically. Two studies investigating the relationship between neighborhood socioeconomic status (SES) and HS severity reported contrasting results. We examine whether neighborhood SES is associated with HS severity at diagnosis within a health system using a census tract-level measure of neighborhood SES, adjusting for individual-level confounders and accounting for census tract clustering. In our cross-sectional study of 462 patients with a new HS diagnosis, patients residing in lower SES neighborhoods had greater odds of Hurley stage 2-3 disease in age- and sex-adjusted models (OR = 1.69, 95% confidence interval = 1.15-2.50, P = .008). Additional adjustment for race and ethnicity revealed a positive association that was not statistically significant (adjusted OR = 1.37, 95% confidence interval = 0.88-2.14, P = .16). Further adjustment for insurance type did not attenuate effect size. We observed evidence of a multiplicative interaction between neighborhood SES and race and ethnicity (P = .02). Residing in lower SES neighborhoods was associated with greater odds of moderate-severe HS at diagnosis. The relationship between neighborhood SES and race and ethnicity is complex, warranting further investigation.