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Comparative Overall Comorbidity Burden Among Patients With Hidradenitis Suppurativa

Educational Objective
To understand the comorbidity burden of hidradenitis suppurativa and compare it with psoriasis.
1 Credit CME
Key Points

Question  What is the overall burden of comorbid disease in patients with hidradenitis suppurativa?

Findings  In this cross-sectional study of 3818 patients in each of 3 matched cohorts, patients with hidradenitis suppurativa had a mean Charlson Comorbidity Index score of 1.95, which was significantly higher than mean CCI scores of age-, sex-, and race-matched cohorts of patients with psoriasis (Charlson Comorbidity Index score, 1.47) and a control group (Charlson Comorbidity Index score, 0.95).

Meaning  The overall comorbidity burden in patients with hidradenitis suppurativa has implications for mortality risk and resource use, and it may warrant multidisciplinary implementation of routine screening measures.


Importance  The overall comorbidity burden among patients with hidradenitis suppurativa (HS) has not been systematically evaluated.

Objectives  To investigate the standardized overall comorbidity burden among patients with HS and to compare it with the comorbidity burden in patients with psoriasis and a control group.

Design, Setting, and Participants  A cross-sectional analysis was conducted of 5306 patients with HS, 14 037 patients with psoriasis, and 1 733 810 controls identified using electronic health records data from October 1, 2013, through October 1, 2018.

Main Outcome and Measure  The primary outcome was the mean Charlson Comorbidity Index (CCI) score.

Results  Each matched cohort had 3818 patients (2789 women and 1029 men; mean [SD] age, 45.7 [15.0]). Before matching, the overall mean (SD) CCI score was highest among the psoriasis cohort (2.33 [3.13]), followed by the HS cohort (1.80 [2.79]) and control cohort (1.26 [2.35]). In matched analyses, the overall mean (SD) CCI score was highest among the HS cohort (1.95 [2.96]), followed by the psoriasis cohort (1.47 [2.43]; P < .001) and control cohort (0.95 [1.99]; P < .001) patients. A total of 516 patients with HS (13.5%) had an overall mean CCI score of 5 or greater. Mean CCI score was highest for patients with HS across all sex, race, and age groups. The most common comorbidities among patients with HS were chronic pulmonary disease (1540 [40.3%]), diabetes with chronic complications (365 [9.6%]), diabetes without chronic complications (927 [24.3%]), and mild liver disease (455 [11.9%]). Patients with HS with a CCI score of 5 or greater had 4.97 (95% CI, 1.49-16.63) times the adjusted risk of 5-year mortality compared with patients with HS with a CCI score of zero.

Conclusions and Relevance  Patients with HS have a higher overall comorbidity burden compared with patients with psoriasis and a control group. A significant proportion of patients with HS have CCI scores of 5 or greater, which are associated with increased mortality. This degree of comorbidity burden may warrant multidisciplinary implementation of routine screening measures.

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Article Information

Accepted for Publication: December 22, 2018.

Corresponding Author: Amit Garg, MD, Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Ave, Ste 300, New Hyde Park, NY 11042 (

Published Online: April 17, 2019. doi:10.1001/jamadermatol.2019.0164

Author Contributions: Mr Strunk and Dr Garg had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Strunk, Garg.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Reddy, Garg.

Critical revision of the manuscript for important intellectual content: Strunk, Garg.

Statistical analysis: Strunk, Garg.

Obtained funding: Garg.

Administrative, technical, or material support: Reddy.

Supervision: Garg.

Conflict of Interest Disclosures: Dr Garg reported serving as a consultant to AbbVie, Pfizer, Janssen, and Asana Biosciences; receiving honoraria from AbbVie, Pfizer, Janssen, and Asana Biosciences; and receiving research grants from AbbVie, UCB, and the National Psoriasis Foundation. No other disclosures were reported.

Funding/Support: This study was supported in part by an education grant from AbbVie.

Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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