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Hidradenitis suppurativa and socioeconomic status: Food for thought (and benefit)

DII small banner By Warren R. Heymann, MD
Oct. 2, 2016

We see many patients with hidradenitis suppurativa (HS), especially in our Camden practice. I am certainly not surprised by the well-documented comorbidities of obesity and smoking (1), which may play a role in the pathogenesis of the disease. While studies confirm that HS has a major impact on quality of life (2), all you need to do is just listen to the patient to know that it is a miserable disease.

As Camden is one of our nation’s poorest cities, I read the article by Deckers et al associating HS with low socioeconomic status (SES) with particular interest. Their hypothesis was that because obesity and smoking is associated with low SES, it is likely that HS is as well. The results of their study was that “the SES distribution among 1018 patients with HS was significantly lower than among 2039 age- and sex-matched dermatologic control patients (P < .001). In patients with HS a low SES was associated with axillary involvement (odds ratio 1.42, P = .04), high body mass index (odds ratio 1.03, P = .003), and lower age at inclusion (odds ratio 0.98, P = .001), but not with disease severity or age of disease onset.” In their discussion they state: “We anticipated that if HS led to a lower SES, patients with younger age of onset and more severe disease would have a lower SES because of missed education or job opportunities and thereafter the inability to perform their jobs or frequent sick leave. However, we did not find a difference in Hurley stage distribution or age of onset among the SES groups. Previous studies reported that 60% to 80% of the patients with HS had secondary or tertiary education. However, education level alone is not reliable for determining SES, because there is only a modest correlation between education level and income. In addition, the number of workdays missed by patients with HS seems limited. Therefore it is possible that the lower SES was pre-existent to HS.” (3).

Perhaps I am biased by my experience, but I think it is likely that lower SES is pre-existent to HS in many cases, especially for the increasing number of young patients that I am seeing with the disease.

I am writing this as the Jewish New Year of 5777 unfolds; at this time we are asked to reflect upon our self and our world. The elections are upon us, and regardless of who is elected, changes in health care are on the horizon. For cities like Camden, where people may not have access to suburban supermarkets, with abundant fresh fruits and vegetables, is it any surprise that obesity runs rampant when all that is available is caloric processed food from the local bodega? Finally, after several decades a new, modern supermarket opened in Camden in 2014 (4). It will take more than just opening a single grocery store to change the dynamic. More are needed but so is education about nutrition and health. That will cost time and money. What is more beneficial in the long run — the cost of such programs or the $2651.78 per adalimumab injection to suppress HS (according to Epocrates)?

1. Wollina U, et al. Comorbidities, treatment, and outcome in severe anogenital inverse acne (hidradenitis suppurativa): a 15-year single center report. Int J Dermatol 2016; Aug 6 [Epub ahead of print].
2. Janse IC, et al. Sexual health and quality of life are impaired in hidradenitis suppurativa: A multicenter cross-sectional study. Br J Dermatol 2016 Aug 18 [Epub ahead of print].
3. Deckers IE, et al. Hidradenitis suppurativa (HS) is associated with low socioeconomic status (SES): A cross-sectional reference study. J Am Acad Dermatol 2016; 75: 755-9.
4. Laday, S. Camden Price-Rite first grocery store to open in the city in decades. South Jersey Times October 14, 2014.

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