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  • Title: Equity and Outcome Events in Hidradenitis Suppurativa: Exploring Effect Modifiers Associated with Diagnostic Delay in the Real World.
    Author: Murray N, Truman I, Milligan G, Modi H, Adlard N.
    Journal: Dermatol Ther (Heidelb); 2024 Dec; 14(12):3211-3227. PubMed ID: 39487935.
    Abstract:
    INTRODUCTION: Patients with hidradenitis suppurativa (HS) experience significantly delayed diagnoses of 7-10 years from symptom onset on average, but the reasons for this remain largely unknown. This study investigated drivers of diagnostic delay from the perspective of healthcare system equity. METHODS: A literature review was performed to identify published factors associated with delayed HS diagnosis to inform data analysis. Clinical and demographic data from the Adelphi HS Disease Specific Programme (DSP)™, a real-world cross-sectional survey of dermatologists and their consulting patients in France, Germany, Italy, Spain, the UK and the USA in 2020/2021, were used to model factors influencing delay to diagnosis from onset of symptoms and first consultation. RESULTS: Factors influencing delay to HS diagnosis in the literature with the most available evidence were misdiagnosis, delay in specialist referral and patient embarrassment. Data analysis revealed that increasing age was associated with reduced diagnostic delay after symptom onset. Patients with HS who were White or in Germany were also more likely to receive a faster diagnosis. Smokers, patients with concomitant conditions, or a family history of HS were slower to be diagnosed. When time to diagnosis following first consultation was assessed, increasing age was associated with quicker diagnosis. Moreover, patients with a family history of HS were diagnosed quicker, whereas those with high body mass index, more concomitant conditions, in employment, managed by multiple physicians or European were more delayed. CONCLUSION: On the basis of a thorough analysis of real-world data, multiple factors that potentially influenced the timely diagnosis of HS have been identified. For the first time, this study quantifies the relative impact of these modifiers, providing valuable insights into areas that require attention for faster diagnoses and improved disease outcomes. Hidradenitis suppurativa (HS) is a painful long-term skin disease, leaving patients with lumps and wounds, tunnels on their skin, and odour. Less than 1% of the population have HS, and patients often have to wait years to get a correct diagnosis and treatment. However, the reasons for this delay are not very clear. We used data from a survey of patients with HS and their treating doctors to investigate what might cause these delays. The survey was done in Europe and the USA in 2020/2021. Firstly, we looked at the time between when patients first noticed symptoms and when they were diagnosed. Older patients, White patients and patients in Germany were quicker to be diagnosed. Those who smoked, had other medical conditions or a family history of HS took longer to get a HS diagnosis. We next looked at the time between when patients first saw their doctor about their symptoms and received their diagnosis. Here, patients who were older or had a family history of HS were quicker to be diagnosed. Patients who were overweight or had other conditions were slower to be diagnosed. This was also the case for those patients who worked, were managed by multiple doctors or were in Europe. Knowing what affects the time to a HS diagnosis will help to inform healthcare professionals on educational aspects pertinent to HS which may help diagnose patients with HS quicker. This may mean they will get the right treatment faster.
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