Dermatology: Practical and Conceptual Commentary | Dermatol Pract Concept. 2024;14(1):e2024060 1 Specialty Utilization Disparities Among Hidradenitis Suppurativa Patients in a Retrospective Analysis of the National Ambulatory Medical Care Survey 2006-2016 Katie Roster1, Ahmad Rajeh2, Shari R. Lipner3 1 New York Medical College, New York, New York, USA 2 University of Missouri-Columbia, School of Medicine, Columbia, Missouri, USA 3 Department of Dermatology, Weill Cornell Medicine, New York, New York, USA Citation: Roster K, Rajeh A, Lipner SR. Specialty Utilization Disparities Among Hidradenitis Suppurativa Patients in a Retrospective Analysis of the National Ambulatory Medical Care Survey 2006-2016. Dermatol Pract Concept. 2024;14(1):e2024060. DOI: https://doi .org/10.5826/dpc.1401a60 Accepted: April 9, 2023; Published: January 2024 Copyright: ©2024 Roster et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: Dr. Lipner has served as a consultant for Hoth Therapeutics, Ortho Dermatologics, Moberg Pharmaceuticals, and Belle Torus Corporation. There are no conflicts of interest declared for the other authors. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Shari R. Lipner, M.D., Ph.D. Department of Dermatology, Weill Cornell Medicine. Email: shl9032@med.cornell.edu Hidradenitis suppurativa (HS) is a chronic inflammatory disease, with patients often having delayed diagnosis and significant impact on quality of life [1]. Compared to other inflammatory diseases, HS required more emergency depart- ment visits (7.4% versus 4.2%, P < 0.0001) and admissions (5.1% versus 2.5%, P < 0.0001), according to a medical claims database study 2008-2012. In a United States (US) retrospective analysis of 47,690 HS patients, Blacks were three times more likely to be diagnosed with HS compared to Whites [3]. Therefore, we aimed to investigate healthcare uti- lization among US Non-Hispanic Whites (NHW) and skin of color (SoC) HS patients. The National Ambulatory Medical Care Survey (NAMCS) 2006-2016 was queried for HS visits. Non-Hispanic Black, Hispanic, Asian, and Pacific Islander patients were grouped as SoC. Specialty utilization, insurance status, appointment wait time, number of previous visits, visit time, and ap- pointment location were analyzed. Analysis of variance and chi-squared test were conducted using SPSS. Multinomial logistic regression analysis examined specialty utilization differences between groups. There were an estimated 2,551,126 outpatient HS vis- its during the study period (1,777,020 NHW, 774,106 SoC). On average, SoC versus NHW patients were younger (33.6 years versus 37.9, P = 0.015) and had more previous visits (5.25  versus 3.99, P = 0.020). On chi-squared anal- ysis, NHW patients were more often seen by dermatology (33.6%) versus family medicine (27.0%) or general surgery (18.7%), while SoC HS patients were more frequently seen by general surgery (35.9%) or family medicine (34.2%) ver- sus dermatology (10.7%) (P = 0.006, all) (Table 1). Using multinomial logistic regression, NHW versus SoC patients were more often seen by dermatology, after adjusting for in- surance type (OR: 3.288, 95% CI:1.324-8.167, P = 0.010). There were no statistically significant differences for sex, insurance type, appointment wait time, visit time, or location. 2 Commentary | Dermatol Pract Concept. 2024;14(1):e2024060 We identified significant healthcare specialty utilization disparities between NHW and SoC HS patients, validating a single institution retrospective analysis of 2,213 HS patients 2017-2020, reporting that Blacks versus Whites were treated less often by dermatology or primary care, and more often by surgery for HS-related visits. A cross-sectional commercial database study 2007-2017 reported that dermatologists versus non-dermatologists pre- scribed opiates less often (OR: 0.23, 95% CI:  0.17-0.31) and prescribed nonantibiotic systemic medications more fre- quently (OR: 6.44, 95% CI: 4.87-8.52) to HS patients [4]. In a retrospective NAMCS analysis 1990-2009, dermatolo- gists managed HS patients with a combination of procedure and medications more often than versus non-dermatologists (15% versus 6%), while non-dermatologists were more likely to provide neither medication nor procedural treatments (28% versus 2%) [5]. Therefore, limited dermatologist access might contribute to non-evidenced based HS management, particularly among SoC patients, which could explain their having more frequent appointments and being treated surgi- cally rather than medically. Non-NHW patients were designated as SoC, limiting differentiation among racial/ethnic groups. Socioeconomic status and education level, which influence healthcare utili- zation, were not studied. In sum, we identified significant healthcare specialty utilization disparities between NHW and SoC HS patients, with NHW patients more likely to be seen by dermatologists and requiring fewer visits. These findings underscore the im- portance of addressing dermatologic care barriers, particu- larly for SoC HS patients, to optimize disease management and reduce the need for surgical intervention. Table 1. Differences in Non-Hispanic Whites NHW skin of color and SoC hidradenitis suppurativa patients. NHW N = 1,777,020 SoCN = 774,106 P-value Age (SE) 37.91 (0.94) 33.59 (1.48) 0.015 Sex, N (%) 0.065 Male 563,880 (31.7) 121,455 (15.7) Female 1,213,140 (68.3) 652,651 (84.3) Specialty, N (%) 0.006 Dermatology 596,488 (33.6) 82,797 (10.7) General Surgery 332,290 (18.7) 277,788 (35.9) Family Medicine 478,955 (27.0) 264,447 (34.2) Other 369,288 (20.9) 149,074 (19.2) Time until appointment, N (%) 0.056 <1 week 394,819 (22.2) 173,700 (22.4) 1-2 weeks 288,242 (16.2) 243,986 (31.5) >2 weeks 62,4911 (35.2) 138,229 (17.9) Unknown 469,049 (26.4) 218,192 (28.1) Insurance status, N (%) 0.477 Private 1,024,173 (57.6) 470,576 (60.7) Medicaid or Medicare 653,592 (36.8) 249,401 (32.2) Self-pay 54,915 (3.1) 50,012 (6.5) Unknown 44,340 (2.5) 4,118 (0.5) Number of previous visits, mean (SE) 3.99 (0.35)  5.25 (0.34) 0.020 Appointment time, mean (SE) 19.19 (0.92) 20.91 (1.2) 0.239 Location, N (%) 0.987 Metropolitan 1,652,282 (93.0) 720,540 (93.1) Non-metropolitan 124,739 (7.0) 53,567 (6.9) NHW = Non-Hispanic White; SoC = skin of color (Asian or Pacific Islander, non-Hispanic Black, and Hispanic); SE = standard error. Tables (NHW) and (SoC) HS patients. Commentary | Dermatol Pract Concept. 2024;14(1):e2024060 3 References 1. Udechukwu NS, Fleischer AB Jr. Higher Risk of Care for Hidra- denitis Suppurativa in African American and Non-Hispanic Pa- tients in the United States. J Natl Med Assoc. 2017;109(1):44-48. DOI: 10.1016/j.jnma.2016.09.002. PMID: 28259215. 2. Khalsa A, Liu G, Kirby JS. Increased utilization of emergency department and inpatient care by patients with hidradenitis suppurativa. J Am Acad Dermatol. 2015;73(4):609-614. DOI: 10.1016/j.jaad.2015.06.053. PMID: 26190241. 3. Robinson I, Lee L, Cotton C. The Impact of Racial Differences on Treatment Strategies in Hidradenitis Suppurativa: A Retro- spective Review. J Drugs Dermatol. 2022;21(3):270-275. DOI: 10.36849/JDD.6446. PMID: 35254766. 4. Wehner MR, Micheletti R, Noe MH, Linos E, Margolis DJ, Naik HB. 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