Demography, Incidence, Prevalence, and Comorbidities in Hidradenitis Suppurativa: Insights from a Large-Scale Database Analysis

Abstract Background and Aims: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by painful nodules, abscesses, and draining tunnels in intertriginous regions. Despite extensive research since its description in 1854, the global prevalence remains highly variable (0.053%-4.1%), with notable disparities across demographic groups. This study examines demographic patterns and prevalence trends of HS in the United States to inform targeted public health strategies and improve patient outcomes through early diagnosis and intervention. Methods: This retrospective cohort study analyzed HS incidence, prevalence, and trends from January 1, 2014 to December 31, 2024, using a de-identified electronic health record database (TriNetX platform). The cohort included patients diagnosed with HS via ICD codes. Primary outcomes were incidence proportion, prevalence, and incidence rate. Secondary analyses stratified data by age, race, and ethnicity. Patients with incomplete demographic data or insufficient follow up were excluded. Results: Over the 10-year period, 455,430 HS patients were identified from a base population exceeding 211 million individuals. Incidence proportion increased from 0.07 per 1,000 in 2014 to 0.94 per 1,000 in 2024, with prevalence and incidence rates showing similar upward trends. The greatest increases were observed among younger age groups, American Indian/Alaska Native and Asian populations, and Hispanic or Latino individuals. African Americans represented 30.2% of HS cases, indicating a disproportionate disease burden relative to their population representation. Conclusion: HS incidence and prevalence have increased significantly over the past decade, particularly among specific racial, ethnic, and age groups. These trends likely reflect improved disease recognition, enhanced diagnostic awareness, and expanded healthcare access following policy changes such as the Affordable Care Act. The rising disease burden underscores the need for innovative multidisciplinary treatment strategies and continued research into genetic, inflammatory, and metabolic factors to identify novel therapeutic targets and improve patient outcomes.