Hidradenitis Suppurativa Claims Data: Sex Parity and Rural Care Gaps

Two hidradenitis suppurativa (HS) claims data analyses presented at Fall Clinical 2026 examined prevalence by sex and access to care by geography.^1,2 One reported similar prevalence of HS-related symptoms between males and females without a formal diagnosis.¹ The other found rural patients with HS were less likely than urban patients to access dermatologists.²

The first analysis tested the traditional 3:1 female predominance reported for HS by comparing patients with a formal diagnosis with those defined by recurrent HS-related symptoms.¹ The second evaluated whether geographic location, a social determinant of health, is associated with health care resource utilization (HCRU) and access to dermatology care.² UCB funded both studies.

In the first analysis, Lev-Tov et al used Komodo Health US claims data from more than 300 million patients from October 2016 to December 2024. Age-adjusted, sex-specific annual prevalence was reported from 2017 to 2024 for 2 mutually exclusive groups. The first had an ICD-10 HS diagnosis code (L73.2), and the second had HS-related symptom-defined disease, based on at least 5 claims on distinct dates for abscess, furuncle, or pilonidal cyst.¹

Approximately 2.4 million patients were included, with approximately 1.6 million in the diagnosis group and 0.8 million in the symptom-defined group. Patients with claims for pilonidal cyst alone were excluded, and all analyses were descriptive.¹

Diagnosed HS prevalence among males and females was 62 and 148 cases per 100,000 population in 2017 and 97 and 253 per 100,000 in 2024. Symptom-defined disease was more balanced, with slight male predominance. Prevalence among males and females was 43 and 37 per 100,000 in 2017 and 67 and 54 per 100,000 in 2024.¹

The authors noted similar symptom prevalence between sexes runs counter to current knowledge of markedly higher HS prevalence in females. They wrote the findings may suggest underdiagnosis in males and highlight the need to reduce diagnostic disparities between male and female patients.¹

Rural Versus Urban Access to Dermatology Care in HS

In the second analysis, Achter et al used STATinMED RWD Insights all-payer medical and pharmacy claims from January 1, 2014, to November 30, 2024. Eligible patients were aged 12 years or older with an ICD-9 or ICD-10-CM code for HS or for HS symptoms without a diagnosis, plus 12 months of continuous enrollment before and after index.²

Patients without a diagnosis required at least 2 visits, 30 days to 12 months apart, with claims for abscess, cyst, boil, furuncle, or folliculitis. Groups were compared using chi-squared tests.²

The analysis included 1,763,183 patients, of whom 51,030 (2.9%) were rural and 1,712,153 (97.1%) were urban. Overall, 17% (n=297,982) had an HS diagnosis and 83% (n=1,465,201) had symptoms without a diagnosis. Mean age was similar (52 vs 51 years), and both groups were 59% female.²

At index, 12% of rural vs 24% of urban patients received an HS diagnosis from a dermatologist, and 27% vs 17% from family medicine specialists. During follow-up, dermatologist access was significantly lower among rural vs urban patients with diagnosed HS (15% vs 26%) and with undiagnosed symptoms (23% vs 41%; both P<.001). Primary care access was higher in rural patients (87% vs 76% and 87% vs 72%, respectively; both P<.001).²

Biologic use for any indication was low (2.8% rural vs 3.1% urban; P=.139) and most commonly prescribed by rheumatologists, followed by dermatologists. Rural patients had significantly more all-cause outpatient hospital visits at baseline and follow-up (both P<.001) and substantially higher opioid and non-opioid pain medication use. HS-related outpatient hospital visits were also more common among rural patients at baseline (2.6% vs 1.9%) and follow-up (39% vs 25%; both P<.001).²

The authors concluded rural and urban patients with HS differ significantly in access to dermatologist care and HCRU. Rural patients relied more on primary care for HS management.²

Disclosure: Authors of both abstracts included UCB employees, and Costello Medical provided medical writing support.^1,2

References

1. Lev-Tov H, Ingram JR, Hsiao J, et al. Sex-specific and age-adjusted prevalence of hidradenitis suppurativa: results from Komodo US claims data suggest sex parity of HS symptoms. Poster presented at: 2026 Fall Clinical Dermatology Conference; October 8-11, 2026; Las Vegas, NV
2. Achter E, Aweh G, Antonucci M, et al. Social determinants of health in rural versus urban patients with hidradenitis suppurativa. Poster presented at: 2026 Fall Clinical Dermatology Conference; October 8-11, 2026; Las Vegas, NV