Understanding disparities in hidradenitis suppurativa through social and structural determinants of health

Abstract

Abstract Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with a global prevalence and presentation that varies widely and is influenced by both intrinsic and extrinsic factors. While research into disease heterogeneity and burden has traditionally focused on biological and genetic differences (i.e., intrinsic factors), emerging evidence suggests that social determinants of health (SDOH) and structural determinants of health (StDOH) (i.e., extrinsic factors) play a pivotal role in the disparities observed in HS. This narrative review consolidates insights on the influence of SDOH and StDOH on HS incidence, severity, and health disparities. We highlight the importance of SDOH, including economic stability, education quality and access, healthcare quality and access, neighbourhood environment, and social/community context in shaping HS outcomes. Furthermore, we emphasize the overarching role of StDOH, including government processes, economic policies, social/public policies, and cultural and societal values in determining health outcomes. Addressing these determinants is crucial for devising effective interventions and enhancing patient outcomes. Future research should focus on a holistic understanding of HS, moving beyond a purely biological perspective to consider the intricate interplay of social and structural determinants.

Keywords

• health disparities
• hidradenitis suppurativa
• social determinants
• structural determinants