Gender and Age-Related Differences in Biologic Treatment Among Patients with Hidradenitis Suppurativa

Biologic therapies have demonstrated significant efficacy in reducing disease burden in hidradenitis suppurativa (HS). However, prolonged delays in treatment access remain common, particularly among marginalized populations. While pediatric disparities in biologic use for HS patients are documented, little is known about treatment inequities in adult populations. Understanding these disparities in biologic access is critical, as delayed initiation of appropriate therapies may represent a missed opportunity to prevent disease progression. Therefore, the current study utilizes data from the All of Us database to examine sociodemographic factors associated with biologic therapy use in adults with HS. Data was obtained from 3,308 adults diagnosed with HS. Multivariable regression was used to assess two outcomes: (1) odds of biologic use and (2) time to biologic initiation based on age, gender, race/ethnicity, income, insurance status, rurality, and health literacy. Smoking status was controlled for across all analyses. The time-to-treatment analysis was restricted to the 195 patients who received biologic therapy. On average, patients were 51.1 years old, predominantly female, non-Hispanic/Latino, insured, and did not report delayed care due to rural residence. Age and sex emerged as important sociodemographic factors influencing biologic therapy use and timing. When examining the odds of receiving biologic therapy, age was the only significant predictor. Specifically, each additional year of age was associated with a 2% decrease in the odds of receiving biologics (OR = 0.98; 95% CI: 0.97–0.99; p < 0.001). In the analysis of time to biologic initiation, both age and gender were significant predictors. Each year increase in age is associated with a 29-day longer delay in starting biologic therapy (β = 29.29; 95% CI: 6.74–51.84; p = 0.01). Similarly, female gender was associated with a significantly longer time to biologic initiation compared to males (β = 1071.52; 95% CI: 369.11–1773.94; p = 0.003). These findings underscore the need for clinician awareness of age and gender related disparities in HS management. Older adults may be under-prioritized for biologic therapy due to prescribing biases or under-recognition of disease severity. Ensuring timely, equitable access is critical to improving outcomes and quality of life for patients with HS.