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HS Disease Trajectory Includes Several Comorbidities

A recent population-based study indicated that several comorbidities, such as type 1 diabetes and depression, often precede a diagnosis of hidradenitis suppurativa (HS). Patients with HS also had a high risk of chronic obstructive pulmonary disease (COPD), pneumonia, and acute myocardial infection (AMI), according to the study published in JAMA Dermatology.

HS has been associated with multiple comorbidities, but “previous studies have been of cross-sectional design and the temporal associations of HS with [these] comorbidities remains undetermined,” the researchers said. They evaluated and characterized disease trajectories using registry data of the entire Danish population between January 1, 1994, and April 10, 2018, which included 7,191,519 unique individuals.
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The researchers identified 14,488 Danish individuals with HS using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) or surgical procedure codes. A total of 11,929 individuals were identified by ICD-10 diagnosis code (8392 [70.3%] female; mean age 37.72 years), and 2791 were identified by procedural codes (1686 [60.4%] female; mean age 37.38 years).

The researchers assessed disease trajectories more frequently experienced by patients with HS compared with the overall Danish population. In addition, they examined the strength associations between disease co-occurrences using relative risk (RR), and tested directionality of all significant disease pairs using a binomial test. The researchers merged pairs with directionality into disease trajectories of 3 consecutive diseases and combined numerous disease trajectories into a disease progression network that showed the most frequent disease paths over time for patients with HS. 

“The set of most common temporal disease trajectories included 25 diagnoses and had a characteristic appearance in which genitourinary, respiratory, or mental and behavioral disorders preceded the diagnosis of HS,” the researchers said. Diseases that preceded HS included depression, type 1 diabetes, asthma, and inflammatory diseases of vagina and vulva, which the researchers found converged on cutaneous abscesses, progressed to HS, and continued on to hypertension, COPD, pneumonia, AMI, and chronic ischemic heart disease.

In addition, the researchers found that patients with ICD-10 diagnosed HS who died during follow-up were more likely to receive a diagnosis of AMI, COPD, or pneumonia compared with those alive at the end of the study period.

“These findings suggest that physicians who treat patients with newly diagnosed HS should be aware of the higher frequency of type 1 diabetes and other inflammatory diseases. Furthermore, during subsequent care, physicians should note that patients with HS have a higher yearly risk of AMI, COPD, and pneumonia than their age- and sex-matched peers,” the researchers concluded.

Kjærsgaard Andersen R, Jørgensen IF, Reguant R, Jemec GBE, Brunak S. Disease trajectories for hidradenitis suppurativa in the Danish population [Published online May 20, 2020]. JAMA Dermatol. doi:10.1001/jamadermatol.2020.1281

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