Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2024;14(4):e2024224 1 Association of Black Race with Demographic, Comorbidities, and Outcome Variables in Localized Scleroderma Patients: A Retrospective Analysis of the 2017 US National Inpatient Sample Keshav D. Kumar1, Amar D. Desai1, Shari R. Lipner2 1 Rutgers New Jersey Medical School, Newark, NJ, USA 2 Department of Dermatology, Weill Cornell Medicine, New York, NY, USA Key words: localized scleroderma, morphea, linear scleroderma, scleroderma, race, racial disparities Citation: Kumar KD, Desai AD, Lipner SR. Association of Black Race With Demographic, Comorbidities, and Outcome Variables in Localized Scleroderma Patients: A Retrospective Analysis of the 2017 US National Inpatient Sample. Dermatol Pract Concept. 2024;14(4):e2024224. DOI: https://doi.org/10.5826/dpc.1404a224 Accepted: May 13, 2024; Published: October 2024 Copyright: ©2024 Kumar 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: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Shari R. Lipner MD, PhD, 1305 York Avenue, 9th floor. Tel: 646-962-3376. Email: SHL9032@med.cornell.edu Introduction Localized scleroderma (LS), including morphea and linear scleroderma, is an idiopathic autoimmune pathology char- acterized by fibrosis and thickening of the skin and un- derlying tissues. [1,2] LS is more common in females and young children, and while prevalence is similar between races, Black vs White scleroderma patients had more severe presentations in single-center studies. [3] Therefore, we aimed to characterize associations in Black LS patients nationally. Case Presentation The 2017 National Inpatient Sample (NIS) was queried for LS cases using these ICD-10-CM codes: L94.0/L94.1. Mul- tivariable logistic and linear regression analyses assessed associations between the Black race of LS patients and demographic, comorbidity, and outcome variables (P<0.05) (IBM SPSS 25). There was a total of 3,750 LS patients, 63.7% White and 16.4% Black. Black vs. White LS patients were, on aver- age, younger (52.78 [SD:16.91] vs. 58.13 years [SD:18.67], P<0.001). Female (76.7%) vs. male (23.3%) LS patients were more often Black (OR:1.711, 95% CI: 1.292–2.265, P<0.001). Blacks more often had the most associated comor- bidities, including valvular disease, pulmonary circulation disease, diabetes mellitus (DM), hypothyroidism, and renal failure. Black vs. White LS patients had lower likelihoods of liver disease (OR: 0.433, 95% CI: 0.260–0.723, P=0.001), drug abuse (OR: 0.460, 95% CI: 0.220–0.964, P=0.040), and depression (OR: 0.357, 95% CI: 0.250–0.508, P<0.001). Black race did not impact hypertension risk (OR: 1.023, 95% CI: 0.785–1.333, P=0.869) (Table 1). 2 Research Letter | Dermatol Pract Concept. 2024;14(4):e2024224 Black patients had increased lengths of stay (LOS) of 1.012 days (95% CI: 0.080–1.944, P=0.033) and fewer av- erage number of procedures performed (marginal difference -0.289, 95% CI: -0.542–0.037, P=0.025) than White pa- tients. Increased LOS might reflect their previously reported poorer outcomes (at least for systemic scleroderma) due to racial disparities and disease pathogenesis. In a retrospective study of 2,217 systemic scleroderma patients, Blacks had in- creased odds of cardiac (OR: 1.6), renal (OR: 1.6) and muscle diseases (OR: 1.7), and mortality (43% vs. 35%, P=0.001). [3] Therefore, our finding that Black patients more often had comorbid conditions might indirectly explain the increased LOS in Blacks via increased disease severity, but this could also be due to other causes, including economic disparities, mistrust and communication barriers, and less social support versus other groups. Conversely, the lower likelihood of liver disease in Black LS patients might be explained by the commonality of pri- mary biliary cholangitis (PBC) as a liver disease subtype in LS patients, with PBC being more common in Whites. [4] Hypertension risk did not vary between racial groups. This may be due to the pathological association of pul- monary arterial hypertension (and subsequent secondary hypertension) with scleroderma regardless of race, thus min- imizing any racial association with hypertension that might otherwise be seen in the general population. [5] Limitations of this study include its retrospective na- ture and the recording of scleroderma-specific symptoms. Strengths include national breadth and large sample size. Conclusion In sum, Black vs. White LS patients are less likely to have liver disease and inpatient procedures, but higher LOS and risk of DM, hypothyroidism, and renal disease. Dermatol- ogists might keep such associations in mind when treating LS patients, to optimize care and strive toward equitable outcomes. References 1. Kreuter A. Localized scleroderma.  Dermatol Ther. 2012; 25(2):135-147. DOI:10.1111/j.1529-8019.2012.01479.x 2. Careta MF, Romiti R. Localized scleroderma: clinical spectrum and therapeutic update.  An Bras Dermatol. 2015;90(1):62-73. DOI:10.1590/abd1806-4841.20152890 Table 1. Multivariable Adjusted Odds of Black vs White Race on Various Comorbidities in Cutaneous Scleroderma Patients. Comorbidities Adjusted Odds Ratio 95% Confidence Interval P Congestive heart failure 0.836 0.613 - 1.141 0.259 Valvular disease 1.623 1.132 - 2.328 0.008 Pulmonary circulation disease 19.469 8.033 - 47.187 <0.001 Peripheral vascular disease 0.886 0.617 - 1.274 0.514 Paralysis 5.303 2.634 - 10.679 <0.001 Chronic pulmonary disease 0.812 0.612 - 1.077 0.148 Diabetes without chronic complications 1.729 1.061 - 2.816 0.028 Diabetes with chronic complications 2.025 1.46 - 2.81 <0.001 Hypothyroidism 0.327 0.232 - 0.462 <0.001 Renal failure 1.912 1.385 - 2.638 <0.001 Liver disease 0.433 0.26 - 0.723 0.001 Peptic ulcer disease x bleeding 1.030 0.393 - 2.696 0.953 Lymphoma 2.644 0.696 - 10.041 0.153 Solid tumor (no metastasis) 3.126 1.518 - 6.441 0.002 Rheumatoid arthritis 1.317 1.019 - 1.703 0.035 Coagulopathy 0.864 0.565 - 1.323 0.502 Obesity 0.923 0.696 - 1.222 0.574 Fluid and electrolyte disorders 0.910 0.7 - 1.183 0.482 Alcohol abuse 0.868 0.3 - 2.517 0.795 Drug abuse 0.460 0.22 - 0.964 0.040 Depression 0.357 0.25 - 0.508 <0.001 Hypertension 1.023 0.785 - 1.333 0.869 Research Letter | Dermatol Pract Concept. 2024;14(4):e2024224 3 3. Gelber AC, Manno RL, Shah AA, et al. Race and association with disease manifestations and mortality in scleroderma: a 20-year experience at the Johns Hopkins Scleroderma Center and review of the literature. Medicine (Baltimore). 2013;92(4): 191-205. DOI:10.1097/MD.0b013e31829be125 4. Rigamonti C, Bogdanos DP, Mytilinaiou MG, Smyk DS, Rigopoulou EI, Burroughs AK. Primary biliary cirrhosis associated with systemic sclerosis: diagnostic and clinical challenges. Int J Rheumatol. 2011;2011:976427. DOI:10.1155 /2011/976427 5. Naranjo M, Hassoun PM. Systemic Sclerosis-Associated Pul- monary Hypertension: Spectrum and Impact.  Diagnostics (Basel). 2021;11(5):911. Published 2021 May 20. DOI:10.3390 /diagnostics11050911