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Global Patterns of Comorbidities Among Patients With Hidradenitis Suppurativa: A Systematic Review and Meta-Analysis
Aditya K Gupta1,2, Amanda Liddy2, Vasiliki Economopoulos2
1Division of Dermatology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Background:
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder increasingly recognized as a systemic disease with diverse comorbidities. While several comorbid conditions are well documented, regional differences in prevalence remain unclear.
Objective:
The aim of this study was to evaluate regional variation in major comorbidities among HS patients, including diabetes, hypertension, depression, smoking, thyroid disorders, acne, obesity, psoriasis, and inflammatory bowel disease.
Methods:
We performed a meta-analysis of proportions using a generalized linear mixed model with a binomial distribution and logit link to compare the prevalence of HS-associated comorbidities across North America, Europe, and the Middle East/Asia. Analyses were stratified by adult and pediatric populations, with regional N-values incorporated.
Results:
Significant regional differences were observed in metabolic, endocrine, and psychiatric comorbidities. North American patients had higher odds of diabetes compared to Europe (odds ratio [OR] 1.92) and hypertension compared to the Middle East/Asia (OR 2.99). Depression and thyroid disorders were more common in North America (OR 3.46 and 2.32) and Europe (OR 3.19 and 4.01) compared to the Middle East/Asia. Smoking was more prevalent in Europe compared to North America (OR 0.28) and the Middle East/Asia (OR 2.26). Among pediatric patients, anxiety (OR 0.05) and depression (OR 0.16) were more common in North America, while smoking was more frequent outside North America (OR 12.67).
Conclusions:
Regional variation in comorbidity prevalence likely reflects differences in lifestyle, diet, sociocultural norms, healthcare literacy, and access to care. Recognizing these patterns may support earlier identification, guide preventive efforts, and inform individualized management strategies in HS.
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