Study Highlights Factors Associated with Diagnostic Wandering Among Patients with HS

Diagnostic wandering among patients with hidradenitis suppurativa (HS) is associated with several factors, new findings suggest, including being over the age of 40, being female, having an income below minimum wage, and lower educational attainment.¹

These findings and others were the result of a recent analysis of the inflammatory skin condition, the misdiagnosis of which is known to be common and may result in delays in proper therapies. The study highlights significant gender differences in age at diagnosis and diagnostic wandering, with women more frequently experiencing delays.

This research on diagnostic wandering was led in part by C. Fite from the Hôpital Paris Saint-Joseph in Paris, France. ‘Diagnostic wandering’ itself refers to the process in which multiple consultations, tests, or referrals are given to patients without a definitive diagnosis as a conclusion.

“This term often describes situations where healthcare providers are unable to pinpoint the exact cause of a patient's symptoms, leading to a prolonged search for a diagnosis,” Fite and colleagues wrote. “This study aimed to assess diagnostic wandering in HS patients and identify associated factors in France.”¹

Trial Design

The investigators formed a questionnaire designed with guidance provided by both HS specialists and patient advocacy groups. It was approved by the Task Force HS group of the French Society of Dermatology and the team administered it to subjects with confirmed diagnoses of HS across 26 centers between February 2024 - May 2024.

There were 1255 survey respondents, of which 72.1% had been women. The male participants were noted by the team as being notably older compared to female subjects. The males had an average age of 40.2 years versus the average of 33.3 years for females (P = .005).

Information collected by the survey was regarding patients' sociodemographic backgrounds as well as the length of time they had reported delays experienced in the receiving of diagnoses. These delays were measured in weeks, and the research team’s findings were analyzed with focus on gender differences.

The investigative team used a multivariate logistic regression for the purposes of identifying predictors of diagnostic delays. The team assessed various factors such as participants’ level of educational attainment, gender, age, rural or urban region of residence, time since one’s diagnosis, and income level.

Notable Findings

The research team reported that around age 27.1 for women and slightly earlier for men at 25.1 years, HS was shown to develop. They noted that approximately 49% reported earning below the minimum wage.

Diagnostic wandering was also found by the investigators to have been experienced by 68.8% of the study subjects. Among them, it was noted that 73% of women and 57.8% of men had faced delays, and the difference was statistically significant (P < .001).

When looking at the time that had been spent with diagnostic wandering, the researchers concluded that it averaged about 4.5 years for women and 4.1 years for men. However, this difference was not statistically significant (P < .05). They also found that patients who faced delays spoke with an average of 5.2 doctors, as opposed to only 2 clinicians for those who had not reported delays (P < .0001).

During their multivariate analysis, the investigators showed that the factors linked to diagnostic wandering included aged 40 years or more (OR = 1.52, P = .01), being female (OR = 2.26, P < .0001), having an income below minimum wage (OR = 1.52, P = .006), and having low educational attainment (OR = 1.41, P = .028).

Although diagnoses made following 2020 were observed by the research team to be linked with lower odds of diagnostic wandering (OR = .66, P < .001), there was no significant relationship identified between diagnostic wandering and whether subjects lived in rural versus urban areas (OR = .96, P = .99).

“In view of the significant disparities that still exist, particularly affecting vulnerable populations, continued attention and targeted interventions are necessary and enhanced efforts remain crucial to mitigate these disparities and ensure timely and accurate diagnoses, thereby improving outcomes for all HS patients,” they wrote.^1,2

References

1. ^{Fite, C., Taieb, C., Nassif, A., Delage-Toriel, M., Cassius, C., Skayem, C., Le Floc'h, C., Kerob, D., Benhayoun, Y., Bru, M.F., Marion, M., Demessant, A.L., Joubert, J.M., Caillet, G., Halioua, B., Zimmermann, C., Pommaret, E., Nicol, I., Cogrel, O. and Richard, M.A. (2024), Diagnostic wandering in hidradenitis suppurativa: A nationwide cohort study. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.20425.}
2. ^{Gisondi P, Puig L, Richard MA, Paul C, Nijsten T, Taieb C, et al. Quality of life and stigmatization in people with skin diseases in Europe: a large survey from the ‘burden of skin diseases’ EADV project. J Eur Acad Dermatol Venereol. 2023; 37(Suppl 7): 6–14. https://doi.org/10.1111/jdv.18917.}