256 Female sex and white race are associated with Hidradenitis Suppurativa diagnostic delay

Abstract

Background: Although Hidradenitis Suppurativa (HS) is a chronic, inflammatory skin disease estimated to have a prevalence of 1%, the time from onset of symptoms to diagnosis -termed diagnostic delay- is 7 years on average. Late diagnosis may delay disease course-altering treatments and comorbidity management. We aimed to determine if demographic characteristics such as race, gender, median income, and access to dermatologists are associated with HS diagnostic delay. Methods: We conducted a single-center study of patients treated in an HS specialty clinic and included those who met HS diagnostic criteria, provided demographic characteristics and history. Data were summarized using medians and interquartile ranges (IQR) for continuous variables, and frequencies and counts for categorical variables. We used Spearman correlation to examine the relationship between diagnostic delay and continuous variables, and Wilcoxon rank sum tests to compare delay time with categorical variables. Results: Of 221 eligible HS patients, the majority were female (73%) and White (42%) (Black 23%, Asian 9%, Hispanic 12%, other 8%). Median (IQR) age at onset was 19 years (14, 26). Median diagnostic delay was 4 years (1, 10). Younger age at symptom onset correlated with a longer diagnostic delay (p<0.001). Female patients had longer diagnostic delay compared to males (6 years (1, 13) vs. 2 years (0, 6), p=0.01). White patients had longer median diagnostic delay compared to patients of other racial and ethnic backgrounds combined (5 years (2, 14) vs. 3 years (0, 8), p= 0.004). We found no significant correlations between diagnostic delay and either annual household income or density of dermatologists in county of patient residence. Limitations include recall bias and single center data collection. Conclusion: This study identifies demographic characteristics that may be associated with diagnostic delay in HS, including female sex, white race and younger age. Additional studies with larger cohorts are needed to better understand the relationship between demographic characteristics and HS diagnostic time