17101 A retrospective review of delay in diagnosis and dermatology visits characterized by insurance type in patients with hidradenitis suppurativa in a Midwestern population

Hidradenitis suppurativa (HS) is an inflammatory skin condition that is believed to disproportionately affect populations with low socioeconomic status. We searched the Medical College of Wisconsin and Froedtert Health i2b2 electronic data warehouse, including more than 1.3 million patients in Southeast Wisconsin, for patients with an HS diagnosis and ≥3 encounters for HS using ICD9 705.83 and ICD10 L73.2 codes. We randomly characterized 373 of 1190 identified patients by retrospective chart review, excluding patients without an encounter for HS treatment. Of 243 patients with documentation of insurer at the time of HS diagnosis, 25.5% (62) had private insurance, 20.6% (50) had Medicaid, 12.8% (31) had Medicare, and 41.2% (100) were uninsured. 223 of these patients also had documentation of year of symptom onset and year of HS diagnosis. The mean delay in diagnosis was 2.84 years (n = 89) for uninsured patients, 3.86 years (n = 56) for patients with private insurance, 4.6 years (n = 30) with Medicare, and 6.77 years (n = 48) with Medicaid. Of 243 patients with documentation of insurer at the time of HS diagnosis, 64.5% (40) of patients with private insurance, 60.0% (30) with Medicaid, 46.0% (46) of uninsured patients, and 32.3% (10) with Medicare have seen a dermatologist for treatment of HS. Our findings suggest that insurance class, a determinant of access to care, may impact effective management of HS and should be further explored.