Lower Neighborhood SES Linked to Increased HS Severity at Diagnosis

A new study examining the relationship between neighborhood socioeconomic status (nSES) and hidradenitis suppurativa (HS) severity at diagnosis is adding important nuance to how dermatologists and public health experts understand health disparities in chronic skin conditions. According to the cross-sectional analysis of 462 patients newly diagnosed with HS, individuals living in socioeconomically disadvantaged neighborhoods were significantly more likely to present with moderate to severe forms of the disease—a pattern that may be further shaped by racial and ethnic disparities.

The findings, published recently and drawing on census tract-level socioeconomic data, highlight how zip code may be just as relevant as genetic code when it comes to early HS outcomes. Patients residing in lower SES neighborhoods were nearly 70% more likely to be diagnosed at Hurley Stage 2 or 3—the more advanced stages of HS—compared to their counterparts in higher SES areas. This association remained significant even after adjusting for age and sex (OR = 1.69; 95% CI, 1.15–2.50; P = 0.008), reinforcing concerns that environmental and structural factors are contributing to delayed recognition or access to care.

However, the relationship lost statistical significance after adjusting for race and ethnicity (adjusted OR = 1.37; 95% CI, 0.88–2.14; P = 0.16), suggesting these factors may partially mediate or confound the observed disparities. In other words, it’s not just where a patient lives, but also who they are—and how those identities intersect—that influences how and when they are diagnosed with HS.

The researchers stopped short of concluding a causal relationship but emphasized the importance of viewing HS through the lens of structural determinants of health. “Our study sheds light on the complex relationship between neighborhood SES and race and ethnicity,” the authors noted, calling for future studies to unpack modifiable neighborhood factors and explore geographical variability in HS outcomes.

Hidradenitis suppurativa, a chronic inflammatory skin disease marked by painful nodules, abscesses, and scarring, disproportionately affects women and individuals of African descent. It also carries a high burden of comorbidity and psychosocial impact. Early diagnosis and intervention can mitigate long-term damage, but patients often face delays in receiving appropriate care. The findings from this study raise the possibility that such delays may be more common among individuals living in economically deprived areas—a reflection of broader disparities in healthcare access, transportation, health literacy, and provider availability.

Notably, adjusting for insurance type did not significantly reduce the association between low SES and disease severity, underscoring that coverage alone may not be sufficient to close the gap in outcomes. For clinicians, this may be a call to action to incorporate more context into diagnostic decision-making, particularly for patients from historically underserved communities. Identifying patients at risk of delayed HS diagnosis could involve more than a clinical exam—it may require awareness of social determinants that are not captured in the EHR.

While previous reports, including coverage from Practical Dermatology, have documented the link between geography and delayed HS diagnosis, this new research strengthens the case for neighborhood-targeted interventions. Could enhanced community-based screening or dermatology outreach in underserved areas help shift the curve? Are there environmental stressors or lifestyle constraints within low-SES neighborhoods that accelerate HS progression? The study leaves these questions open, but firmly on the table.

In the meantime, dermatology practices may need to expand their understanding of risk factors beyond biology, recognizing that the health of the skin is often a mirror of deeper systemic inequities. As the dialogue around hidradenitis suppurativa continues to evolve, this study serves as a reminder that patient outcomes are shaped not only by what’s under the skin—but also by what surrounds it.