Inpatient Dermatology Mortality by Skin Type: A Retrospective Cohort Study of an Inpatient Dermatology Consultation Database Evaluating Socioeconomic Factors

Abstract Inpatient dermatology consultations play a vital role in the care of hospitalized patients, yet the differences in mortality outcomes by skin type and their relationship to socioeconomic factors remain poorly characterized. We conducted a retrospective cohort study, using a prospectively maintained inpatient dermatology consultation database at a large, urban, academic hospital, including adult patients evaluated from 2021 to 2025. Patients were stratified by Fitzpatrick skin type (FST IV-VI vs. FST I-III), and neighborhood socioeconomic disadvantage was measured using the area deprivation index (ADI). Among 768 patients (1139 total consultations), diagnostic distribution, or the spectrum of conditions for which dermatology was consulted, differed by skin type, with FST IV-VI patients having higher odds of inflammatory diagnosis and lower odds of infectious diagnosis. In-hospital mortality was higher among FST IV-VI patients (13.1% vs. 5.0%) and remained significant after adjustment for intensive care unit (ICU) stay, insurance, language, and ADI (OR 3.46; 95% CI 1.70-7.00; p < 0.001). Overall mortality, time to death, and ICU utilization did not differ by skin type. FST IV-VI patients more often resided in high-deprivation neighborhoods (OR 3.79; 95% CI, 2.82–5.09; p < 0.001), but ADI was not associated with any mortality outcome. Mortality disparities by skin type were confined to in-hospital events and were not explained by illness severity or neighborhood deprivation, suggesting a possible role for differences in disease presentation, diagnostic approach, or hospital-level systemic factors.