Hidradenitis Suppurativa Care Utilization in Adults vs Children

Healthcare utilization patterns among children and adults with hidradenitis suppurativa (HS) were outlined in study data published in JAMA Dermatology. Compared with adult patients, pediatric patients more often utilized high-cost emergency department care for HS, despite the disorder’s manageability in an outpatient setting. Children were also more likely to receive diagnoses of folliculitis and comedones before an HS diagnosis. These results suggest that HS may be underdiagnosed in pediatric practice. Improved understanding of the pediatric signs and symptoms may aid in early recognition and appropriate treatment referral, the researchers believe.

Investigators conducted a retrospective claims analysis using data from the IBM MarketScan commercial database. Individuals who were continuously enrolled in the database from 2012 to 2016 were eligible for inclusion. Pediatric patients were defined as those who received an HS diagnosis before the age of 18 years. Demographic data were extracted from medical records; comorbid disorders were also captured. Healthcare utilization was ascertained based on medical claims. Descriptive statistics were used to summarize the demographic data, healthcare utilization patterns, and healthcare costs of the adult and pediatric cohorts.

The study enrolled 8727 patients with HS, of whom 12.5% were included in the pediatric cohort. Mean age of HS diagnosis was 15 ± 2 years in the pediatric cohort and 40 ± 14 years in the adult cohort. Mean delay from HS symptom onset to HS diagnosis was 0 years among pediatric patients, compared with 3 years among adults (P <.001). The majority of all enrollees were women: 85.8% of the pediatric cohort and 77.1% of the adult cohort.  Pediatric patients were significantly more likely than adult patients to receive a diagnosis of comedones (51.0% vs 42.7%) and folliculitis (27.2% vs 13.6%) before a diagnosis of HS (both P <.001). Pediatric patients were most likely to have been seen by a pediatric clinician (81.7%), family medicine practitioner (66.5%), and a dermatology department (39.8%) before HS diagnosis. The most common practitioners seen by adult patients before diagnosis were in family medicine (60.7%), internal medicine (39.5%), and gynecology (38.7%). The most common comorbidities in the pediatric cohort were acne vulgaris (51.0%), acne conglobate (45.9%), obesity (33.7%), and anxiety disorder (33.6%). The most common comorbidities among adult patients were obesity (43.8%), anxiety disorder (42.1%), hyperlipidemia (33.1%), and acne vulgaris (24.7%).

Compared with adults, pediatric patients were significantly more likely to have received care at an emergency department (35.6% vs 28.2%) or urgent care clinic (18.1% vs 13.4%) before HS diagnosis (both P <.001). After diagnosis, however, the mean number of HS-specific emergency department claims was higher in adults. Mean cost per emergency department claim was comparable between cohorts. The percentage of patients with HS-specific inpatient hospital stays was slightly higher in adults (4.22% vs 2.38%; P =.002), but mean hospital stay was comparable (4.9 vs 6.5 days; P =.49). The total 5-year disease-specific emergency department/urgent care costs were $61,163.74 and $1,324,130.59 in the pediatric and adult cohorts, respectively.

These data provide insight into healthcare utilization in children with HS. High-cost emergency department care was frequently sought by pediatric patients before diagnosis. Improved understanding of the disorder in children among family medicine practitioners and pediatricians may increase diagnostic rates and allow for early referral to specialists, the investigators wrote. In these ways, practitioners can reduce unnecessary emergency visits and costs.

As study limitations, investigators noted that MarketScan data only represents privately insured individuals, and thus may not be generalizable to all patients in the United States. In addition, data on HS severity were not available; further study is necessary to understand the impact of symptom severity on pediatric diagnosis rates and healthcare costs.

“Pediatric patients utilize high-cost ED care when HS in children and adults can often be treated as an outpatient if referred to the proper specialist,” investigators concluded. “These data suggest that there are opportunities to improve recognition of HS in pediatrics by nondermatologists and dermatologists.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Hallock KK, Mizerak MR, Dempsey A, Maczuga S, Kirby JS. Differences between children and adults with hidradenitis suppurativa. JAMA Dermatol. Published online August 11, 2021. doi: 10.1001/jamadermatol.2021.2865