Comparative Overall Comorbidity Burden Among Patients With Hidradenitis Suppurativa

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.