Background: Hidradenitis suppurativa (HS) is associated with lower socioeconomic status (SES). The adverse influence of HS on education and employment may explain this. It remains unknown whether HS causes downward social trajectories, i.e., social drift, or whether those affected are born into a lower SES. We aimed to assess the influence of HS on education and employment and compare the highest educational attainment of participants with their parents. Methods: An anonymous online survey was distributed by patient-led organisations. Frequencies were compared with χ2 and disease interactions with one-way ANOVA. Results: Among 335 respondents from 10 countries, 94.9% completed secondary/high school, 71.3% completed further education, 41.8% completed an undergraduate degree, 20% completed postgraduate education, 10.7% completed a masters, and 2.1% completed a doctorate. Participant education was greater than parental education (p < 0.001). Despite this, 24.2% were unemployed and 15.2% were receiving illness benefit. Compared to national statistics, HS participants from Ireland (p = 0.003), the USA (p < 0.001), and the UK (p < 0.001) were more likely to be unemployed/receiving illness benefit despite higher educational attainment in Ireland (p = 0.006) and the USA (p = 0.003) with similar education in the UK (p = 0.153). Conclusions: Social drift describes downward social trajectories due to the development of a disease. Participants in this study report greater education than their parents and the background population, but despite this, they are experiencing downward social trajectories with higher unemployment and receipt of illness benefit. Disease onset in HS tends to be at peak educational age. Education does not appear to be impaired by early disease with disease accumulation during employment years limiting opportunities.

Hidradenitis suppurativa (HS) is a common chronic inflammatory condition characterised by painful nodules, abscesses, scarring, and draining tunnels predominantly in intertriginous areas [1]. HS is associated with lower socioeconomic status (SES). This has been evaluated previously in cross-sectional studies using Medicaid status as a proxy for low SES in the United States of America (USA) and using mean property values and household income within neighbourhoods in the Netherlands [2, 3]. A retrospective cohort study in the USA identified slower income growth, lower overall income, and increased risk of leaving the workforce in patients with HS [4]. In a study published from Ireland in 2015, 21.3% of patients with HS were unemployed compared to 7.3% of the general population, while 9.4% were in receipt of temporary or long-term illness benefits [5]. Patients reported missing 15.9 days of work due to HS over the course of a year in addition to an estimated 20–25% impairment in productivity at work due to HS [5‒7]. It remains unclear if HS causes downward social trajectories or whether patients are born into a lower SES. Social drift describes downward social trajectories due to the development of a disease and has been assessed indirectly in other conditions by comparing patient educational attainment with parental educational attainment [8]. It is well reported in psychiatric disorders whereby patients begin to drift from a higher to a lower SES just prior to the diagnosis of an illness [9]. Cumulative life course impairment (CLCI) is a model which recognises the impact of disease on quality of life and major life decisions due to the continuous accumulation of disease burden over time [10]. CLCI is well described in psoriasis but has not been evaluated in HS [11].

Our aims were to assess the influence of HS on education and employment and to compare participant highest educational attainment with subsequent rates of employment and parental highest educational attainment as measures of social drift in HS. An anonymous online survey was distributed in partnership with patient-led organisations. Survey responses were collected from February 1 to May 1, 2022. Information was collected on demographics, self-reported Hurley stage, HS treatment, HS duration, and family history of HS. Participants were asked about their highest educational attainment, maternal and paternal educational attainment, and employment status. Statistical analysis was completed using Jamovi (version 2.0, Sydney, Australia). χ2 test was used to compare the frequency of each level of educational attainment between participants, parents, general population census data, and patients with and without a family history of HS. One-way analysis of variance (ANOVA) was used to compare the mean duration of HS and age of HS onset by employment status and levels of educational attainment. Ethical approval was not deemed to be required by the University College Dublin Human Research Ethics Committee (Life Sciences).

Demographics

A total of 335 responses were received from 10 countries including the USA (n = 183, 54.6%), Ireland (n = 64, 19.1%), the United Kingdom (UK) (n = 43, 12.8%), and Canada (n = 25, 7.5%) (Table 1). Most participants were female (n = 311, 92.8%) with a median age of 38 years (IQR 31–46). Hurley stage 3 disease was reported most commonly (n = 118, 35.2%) followed by Hurley stage 2 (n = 86, 25.7%) and Hurley stage 1 (n = 31, 9.3%) with 100 participants (29.9%) unsure of the Hurley stage of their disease. The median duration of disease was 15 years (IQR 8–25), and median age of disease onset was 18 years (IQR 14–27). One-third of participants were not on any treatment (n = 108, 32.2%). Of the 227 participants receiving treatment, 86 were on antibiotics (25.7%), 70 on biologics (20.9%), 30 on other agents (9%), and 13 were undergoing surgery (3.9%). Less frequently reported treatments included spironolactone monotherapy (n = 12), metformin monotherapy (n = 9), combination metformin and spironolactone (n = 3), isotretinoin (n = 2), prednisolone (n = 2), liraglutide (n = 1), and adapalene (n = 1). Complementary and alternative therapies were utilised by 28 participants (8.4%). Over a quarter of participants reported a family history of HS (n = 94, 28.1%), of whom 83 reported a first-degree relative (88.3%), 6 reported a second-degree relative (6.4%), and 5 reported a third-degree relative (5.3%).

Table 1.

Demographics, Hurley stage, and treatment information

MedianIQR
Age, years 38 31–46 
Age of onset, years 18 14–27 
Disease duration, years 15 8–25 
MedianIQR
Age, years 38 31–46 
Age of onset, years 18 14–27 
Disease duration, years 15 8–25 
n%
Gender 
 Female 311 92.8 
 Male 24 7.2 
Country of residence 
 USA 183 54.6 
 Ireland 64 19.1 
 UK 43 12.8 
 Canada 25 7.5 
 Others 20 
Hurley stage 
 1 31 9.3 
 2 86 25.7 
 3 118 35.2 
 Unknown 100 29.9 
Treatment 
 None 108 32.2 
 Antibiotics 86 25.7 
 Biologics 70 20.9 
 Others 30 
 Alternative therapies 28 8.4 
 Surgery 13 3.9 
Family history 
 Yes 94 28.1 
 No 132 39.4 
 Unknown 109 32.5 
n%
Gender 
 Female 311 92.8 
 Male 24 7.2 
Country of residence 
 USA 183 54.6 
 Ireland 64 19.1 
 UK 43 12.8 
 Canada 25 7.5 
 Others 20 
Hurley stage 
 1 31 9.3 
 2 86 25.7 
 3 118 35.2 
 Unknown 100 29.9 
Treatment 
 None 108 32.2 
 Antibiotics 86 25.7 
 Biologics 70 20.9 
 Others 30 
 Alternative therapies 28 8.4 
 Surgery 13 3.9 
Family history 
 Yes 94 28.1 
 No 132 39.4 
 Unknown 109 32.5 

Others includes Australia (n = 7, 2.1%), Puerto Rico (n = 7, 2.1%), India (n = 2, 0.6%), New Zealand (n = 2, 0.3%), Italy (n = 1, 0.3%), South Africa (n = 1, 0.3%).

IQR, interquartile range; n, number.

Educational Attainment

Almost all participants completed secondary/high school (n = 319, 94.9%) (Table 2). The majority of participants reported completing some form of education following school (n = 239, 71.3%) with 41.8% completing an undergraduate degree and 20% completing a postgraduate degree including a master’s degree in 10.7% and a doctoral degree in 2.1%. Just 1.5% of participants had completed primary school only, and 3.6% reported leaving education at the half-way point in secondary school. 24.2% were unemployed (n = 81), while 11% were in receipt of long-term illness benefit (n = 37), and 4.2% were in receipt of temporary illness benefit (n = 14). 48.4% were in full-time employment (n = 162), and 12.2% were in part-time employment (n = 41).

Table 2.

Educational attainment (%)

ParticipantMaternalPaternal
Primary school/elementary school 100 100 100 
Junior certificate/middle school/GCSEs 98.5 91.9 89.6 
Leaving certificate/high school/A levels 94.9 76.1 72.9 
Post-leaving certificate course/diploma/apprenticeship 71.3 43 40.1 
Undergraduate degree 41.8 25.7 20.4 
Postgraduate degree 20 12.6 10.5 
Master’s degree 10.7 6.9 4.5 
Doctoral degree 2.1 0.9 2.1 
  p < 0.001a p < 0.001a 
ParticipantMaternalPaternal
Primary school/elementary school 100 100 100 
Junior certificate/middle school/GCSEs 98.5 91.9 89.6 
Leaving certificate/high school/A levels 94.9 76.1 72.9 
Post-leaving certificate course/diploma/apprenticeship 71.3 43 40.1 
Undergraduate degree 41.8 25.7 20.4 
Postgraduate degree 20 12.6 10.5 
Master’s degree 10.7 6.9 4.5 
Doctoral degree 2.1 0.9 2.1 
  p < 0.001a p < 0.001a 

ap value calculated using χ2 test.

Parental educational attainment was lower than HS participant educational attainment (Table 2). Compared to HS participant educational attainment, there was a lower rate of completion of education following school (maternal n = 144/43%, paternal n = 134/40.1%). Maternal attainment of undergraduate degrees was lower than HS participant attainment (25.8% vs. 41.8%). Maternal attainment of postgraduate degrees was also lower than HS participant attainment (12.6% vs. 20%). Paternal attainment of undergraduate degrees (20.4% vs. 41.8%) and postgraduate degrees (10.5% vs. 20%) was lower than HS participant attainment with the exception of doctoral degrees (2.1% vs. 2.1%). The rates of completion at every level of education were higher for HS participants than their parents. Utilising χ2 test, participants had a significantly higher educational attainment than both their mothers (p < 0.001) and their fathers (p < 0.001). There was no impact of family history of HS on participant (p = 0.22), maternal (p = 0.194), or paternal educational attainment (p = 0.539).

Utilising one-way ANOVA, duration of HS did not influence participant educational attainment (p = 0.205), but there was a trend towards an association between duration of HS and employment status (p = 0.053). The median duration of HS was 15 years (IQR 8–21) in participants in full-time or part-time employment compared to 16 years (IQR 8–25.3) in participants who were unemployed or receiving illness benefit. Age of HS onset did not impact educational attainment (p = 0.105). Participants with a younger age of onset were more likely to be unemployed or in receipt of illness benefit. The median age of onset was 18 years (IQR 14–25.3) in participants who were unemployed or receiving illness benefit compared to 19 years (IQR 15–28) in employed participants (p = 0.032).

Educational Attainment and Employment in the USA

Due to the potential impact of country of residence on employment and educational attainment, individual analysis was completed for participants from the three countries with the highest number of survey participants. Analysis was completed for respondents from the USA, Ireland, and the UK with readily available census and government-reported data for comparison with population norms.

The most recent census data available for the USA with educational information are from 2020 [12]. Data were available for the population aged 25 and over. In 2020, 88.5% of the USA had completed secondary/high school while 61.8% had completed some form of education following school including 32.9% with an undergraduate degree and 12.7% with a postgraduate degree (Table 3). HS survey participants from the USA had a higher educational attainment at all levels from secondary school to doctoral degrees. Utilising χ2, this difference in education was statistically significant (p = 0.003).

Table 3.

Educational attainment in the USA participants compared to the USA census 2020 and in Irish participants compared to the Irish census 2016 (%)

USA participantsUSAIrish participantsIreland
Primary school/elementary school 100 100  100 100  
Junior certificate/middle school/GCSEs 98.8 95.1 +3.7 98.4 97.2 +1.2 
Leaving certificate/high school/A levels 98.8 88.5 +10.3 93.7 88.2 +5.5 
Course/diploma/apprenticeship 72.6 61.8 +10.8 78.1 70.9 +7.2 
Undergraduate degree 43.2 32.9 +10.3 45.3 44.9 +0.4 
Postgraduate/master’s degree 16.9 12.7 +4.2 29.7 17.4 +12.3 
Doctoral degree 1.6 1.2 +0.4 4.7 1.4 +3.3 
   p = 0.003a   p = 0.006a 
USA participantsUSAIrish participantsIreland
Primary school/elementary school 100 100  100 100  
Junior certificate/middle school/GCSEs 98.8 95.1 +3.7 98.4 97.2 +1.2 
Leaving certificate/high school/A levels 98.8 88.5 +10.3 93.7 88.2 +5.5 
Course/diploma/apprenticeship 72.6 61.8 +10.8 78.1 70.9 +7.2 
Undergraduate degree 43.2 32.9 +10.3 45.3 44.9 +0.4 
Postgraduate/master’s degree 16.9 12.7 +4.2 29.7 17.4 +12.3 
Doctoral degree 1.6 1.2 +0.4 4.7 1.4 +3.3 
   p = 0.003a   p = 0.006a 

ap value calculated using χ2 test.

Among HS participants from the USA, 61.7% were in full-time or part-time employment (n = 113), while 31.7% were unemployed (n = 58), and 6.5% were in receipt of temporary or long-term illness benefit (n = 12). During the study time period, just 3.6% of the general USA population were unemployed (3.5% of males and 3.6% of females) [13]. The most recent report on disability beneficiaries in 2019 reported that 4.4% of the population in the USA were in receipt of illness benefit [14]. Using χ2 test, this difference in employment rates was significant (p < 0.001).

Educational Attainment and Employment in Ireland

The most recent census data available for Ireland are from 2016 [15, 16]. Data were available for educational attainment for the population above 15 years of age or within age brackets. The 35–39 year age bracket was used for comparison given the median age of 38 years in the overall study and 37 years in Irish participants. In 2016, 88.2% completed secondary/high school and 70.9% completed some form of post-school education with 44.9% completing an undergraduate degree, 17.4% completing a postgraduate or master’s degree, and 1.4% completing a doctoral degree (Table 3). Comparatively, HS survey participants from Ireland reported a higher educational attainment compared to the census population at all levels. Utilising χ2 test, this difference in rates of educational attainment was statistically significant (p = 0.006).

Among participants from Ireland, 65.6% were in full-time or part-time employment (n = 42), 18.8% were in receipt of temporary or long-term illness benefit (n = 12), and 15.6% were unemployed (n = 10). Comparatively, just 5% of the general population in Ireland were unemployed (4.9% of males and 5% of females) during the same time period, while the most recent statistics for illness benefits from 2016/2017 identified just 8% of the population were in receipt of temporary or long-term illness benefit [17, 18]. Using χ2 test, this difference in employment rate was statistically significant (p = 0.003).

Educational Attainment and Employment in the UK

The UK government report statistics for educational attainment using the national qualifications framework (NQF) at level 2, 3, or 4 and above stratified by age [19]. Individual statistics for each level above this by age are not available. The median age of participants from the UK was 35 years. Comparison to all UK adults aged 18–64 is not likely to be valid as educational attainment has continuously increased in the UK [19]. Thus, survey responses from the UK were transformed to NQF levels to compare with these available statistics [20]. In 2020, 86% of 30–39 year olds qualified to NQF level 2 or above, 72% to level 3 or above, and 56% to level 4 or above [19]. HS survey participants from the UK reported a higher educational attainment at level 2 (95.3%) and 3 or above (74.4%) but not level 4 or above (48.8%) indicating a higher attainment of school completion but lower attainment of undergraduate and postgraduate degrees (Table 4). Using χ2 test, HS survey participants from the UK had a similar rate of educational attainment to the general population (p = 0.155).

Table 4.

Educational attainment in the UK participants compared to UK education and training statistics 2021 (%)

UK participantsUK%
No qualification 4.7 14 −9.3 
NQF level 2 or above 95.3 86 +9.3 
NQF level 3 or above 74.4 72 +2.4 
NQF level 4 or above 48.8 56 −7.2 
   p = 0.155a 
UK participantsUK%
No qualification 4.7 14 −9.3 
NQF level 2 or above 95.3 86 +9.3 
NQF level 3 or above 74.4 72 +2.4 
NQF level 4 or above 48.8 56 −7.2 
   p = 0.155a 

NQF, national qualifications framework.

ap value calculated using χ2 test.

Among participants from the UK, 51.2% were in full-time or part-time employment, 37.2% were in receipt of temporary or long-term illness benefit, and 11.6% were unemployed. Comparatively, unemployment in the UK for the same time period was 3.8%, while 14.4% of the population in the UK were in receipt of illness benefit [21‒23]. Among 25–49 year olds, unemployment was lower at 3% overall, higher for females at 3.1%, and lower for males at 2.9% [24]. Using χ2 test, HS participants from the UK were more likely to be unemployed or receiving illness benefit than the general population (p < 0.001).

We have demonstrated a high level of educational attainment in this international cross-sectional survey of participants with HS. Compared to both paternal and maternal educational attainment, HS participant educational attainment was higher. Comparison of educational attainment in participants from the USA identified a higher rate of completion of all levels of education compared to the general population in 2020. Irish participants had a higher frequency of completion of education at all levels from secondary school to doctoral degrees compared to the general population as of the 2016 census. Among participants from the UK, there was a higher rate of NQF level 2 and 3 qualifications but not level 4 compared to the general population in 2021 with no significant difference overall in educational attainment.

Social drift describes downward social trajectories due to the development of a disease where people move from a higher to a lower SES [8]. Participants in this study with HS report greater educational achievement than their parents but are experiencing downward social trajectories with higher rates of unemployment and receipt of illness benefit when compared to the general population despite greater educational attainment.

Education is a recognised measure of SES and is known to impact significantly on health outcomes [25]. Parental educational attainment is an important predictor of the educational attainment of their children [26]. In all Organisation for Economic Cooperation and Development (OECD) countries, people who have completed higher education are more likely to be employed [27]. However, in this cohort of participants with HS, despite the high level of participant educational attainment, just 60.6% were in full-time or part-time employment, with 24.2% unemployed and 15.2% in receipt of illness benefit. Participants from Ireland, the UK, and the USA were 3–8 times more likely to be unemployed and 2–3 times more likely to be receiving illness benefits compared to population norms. This disconnect between education and employment, together with the results on educational attainment, supports the CLCI model in HS (Fig. 1) [28].

Fig. 1.

Cumulative life course impairment in HS. Description of life trajectory-defining events, i.e., educational attainment, work productivity, and employment as compared to HS onset and progression to final disease severity stage.

Fig. 1.

Cumulative life course impairment in HS. Description of life trajectory-defining events, i.e., educational attainment, work productivity, and employment as compared to HS onset and progression to final disease severity stage.

Close modal

CLCI describes the impact of the accumulation of disease burden, quality of life impairment, psychological, and physical comorbidities on life trajectories [11]. To our knowledge, CLCI has only been assessed in HS with regards to increased number of hospitalisations and risk of psychiatric comorbidities [11]. The median age of disease onset in HS for females is 19 years and for males is 23 years with a median age of disease onset of 18 years in our cohort [29]. Disease progression occurs in HS with accumulation of irreversible scarring and tunnel formation leading to Hurley stage 2 and 3 disease [30]. The median time for progression of patients with Hurley 3 disease from stage 1 to stage 3 is 5 years, while patients with Hurley 2 disease will progress from stage 1 to stage 2 over a 6-year period [30]. It is possible that when HS begins, initially with single recurrent nodules, this is at a time in life when most patients are completing their post-school education with educational attainment not limited by the early disease course. As disease progresses over the following years, the accumulation of scarring and draining tunnels then limits employment opportunity and/or professional advancement. Our results suggest that CLCI due to HS prevents our cohort of highly educated participants achieving their full employment potential.

The concept of CLCI is more established in psoriasis with the impact of physical and psychological comorbidities, stigma, social support, and coping [31]. Psoriasis has also been shown to impact on major life decisions including those relating to education and employment [32]. The CLCI model attempts to recognise reduction in quality of life with disease time reflective in education and employment with the disease placing HS patients on different life trajectories than those they might have experienced in the absence of disease [10]. There are a number of possible factors which may contribute to CLCI in HS in addition to duration of disease as identified in this study. Patients with HS are more likely to experience psychiatric comorbidities and other medical conditions such as inflammatory bowel disease [33, 34]. HS has been shown to have a greater impact on quality of life scores than major adverse cardiac events, lower limb amputation, hepatitis C, inflammatory bowel disease, eczema, acne, and psoriasis [35, 36]. Increasing disease burden, unemployment, lower educational attainment, female sex, and increasing age are associated with decreased quality of life in HS [37, 38]. Qualitative analysis of the experience of patients with HS with regards to psychological distress identified feelings of shame, embarrassment, and disgust [39]. Pain impacted on distress with feelings of powerlessness due to being dismissed by others. Poor coping was also highlighted with social withdrawal and concealment of disease associated with increasing distress. A systematic review of the lived experiences of patients with HS identified a theme of “putting the brakes on life” with the disease, resulting in patients missing out on multiple life events [40]. Greater resilience, social support, and positive coping mechanisms reduce the impact of HS on quality of life [41, 42]. Given this significant burden of physical and psychological comorbidity, stigma, poor coping and resilience, and social isolation experienced by patients with HS, it is not surprising that CLCI may be experienced by our patients [34, 39, 41, 42].

This study is limited as a cross-sectional survey, available only in English, with the potential for ascertainment bias with highly educated patients more likely to complete an online survey. In addition, the majority of participants were female which may impact on employment rates. The inclusion of employment statistics stratified by gender for comparison with participants in Ireland, the UK, and the USA still, however, demonstrates a significant disparity between employment in HS and background population norms. We have demonstrated high educational attainment with high unemployment rates similar to other studies which validates at least partially the population and the results. This is the first study in HS to assess downward social drift and, to our knowledge, the first study to identify CLCI in HS as it relates to education and employment. Participants reported high levels of educational attainment compared to population norms. Despite this, participants were 3–8 times more likely to be unemployed and 2–3 times more likely to be in receipt of illness benefit than the background population. Increasing duration of disease was associated with greater unemployment without a reduction in educational attainment. CLCI due to HS may be preventing this cohort of highly educated participants from achieving their full employment potential. This requires further study to identify the factors involved in CLCI in HS and the impact of reducing disease burden on reversing or preventing CLCI with early diagnosis and intervention.

Patients with HS are more likely to be unemployed despite similar or greater educational attainment.

The authors would like to acknowledge the contributions of the founders of the patient-led organisations HS Ireland (Barry McGrath) and HS Connect (Brindley Brooks and Denise Fixsen) in distributing the survey link.

Ethical approval was not deemed to be required by the University College Dublin Human Research Ethics Committee (Life Sciences). All patients gave written informed consent prior to completing the online survey.

N.K. has received honoraria from AbbVie, UCB, and Janssen and has acted as a sub-investigator in clinical trials for AbbVie, MoonLake, and UCB. C.M. has received honoraria from AbbVie, Janssen, Lilly, UCB, and Almirall and has acted as a sub-investigator in clinical trials for AbbVie. B.M. has received consultancy/advisory boards disease-relevant honoraria from Novartis. D.O. has received honoraria as a speaker and/or advisory board member for AbbVie, Novartis, Lilly, UCB, and Janssen. B.K. has received research support/principal investigator (clinical trials) from AbbVie, Almirall, Janssen, Merck Sharpe Dohme, MoonLake, Novartis, Pfizer, and UCB; been a consultant for AbbVie, Almirall, Celgene, Janssen, Merck Sharpe Dohme, MoonLake, Novartis, Pfizer, and UCB; received honoraria from AbbVie, Almirall, Celgene, Janssen, Lilly, MoonLake, Novartis, Pfizer, and UCB; and been on scientific advisory boards for AbbVie, Almirall, Celgene, Janssen, Lilly, MoonLake, Novartis, Pfizer, and UCB. R.H. has no conflicts of interest to declare.

This study was supported by grant funding from the City of Dublin Skin and Cancer Hospital Charity.

N.K. contributed to study design, data acquisition, data analysis, data interpretation, drafting the manuscript, and revising the manuscript. C.M., R.H., B.M., D.O’K., B.K., and R.H. contributed to study design, data analysis, data interpretation, and critical revision of the manuscript.

Data are not publicly available. Further enquiries can be directed to the corresponding author.

1.
Sabat
R
,
Jemec
GBE
,
Matusiak
Ł
,
Kimball
AB
,
Prens
E
,
Wolk
K
.
Hidradenitis suppurativa
.
Nat Rev Dis Primers
.
2020
;
6
(
1
):
18
.
2.
Wertenteil
S
,
Strunk
A
,
Garg
A
.
Association of low socioeconomic status with hidradenitis suppurativa in the United States
.
JAMA Dermatol
.
2018
;
154
(
9
):
1086
8
.
3.
Deckers
IE
,
Janse
IC
,
van der Zee
HH
,
Nijsten
T
,
Boer
J
,
Horváth
B
et al
.
Hidradenitis suppurativa (HS) is associated with low socioeconomic status (SES): a cross-sectional reference study
.
J Am Acad Dermatol
.
2016
;
75
(
4
):
755
9.e1
.
4.
Tzellos
T
,
Yang
H
,
Mu
F
,
Calimlim
B
,
Signorovitch
J
.
Impact of hidradenitis suppurativa on work loss, indirect costs and income
.
Br J Dermatol
.
2019
;
181
(
1
):
147
54
.
5.
Delany
E
,
Gormley
G
,
Hughes
R
,
McCarthy
S
,
Kirthi
S
,
Markham
T
et al
.
A cross-sectional epidemiological study of hidradenitis suppurativa in an Irish population (SHIP)
.
J Eur Acad Dermatol Venereol
.
2018
;
32
(
3
):
467
73
.
6.
van Straalen
KR
,
Prens
LM
,
Hylkema
TH
,
Janse
IC
,
Dickinson
J
,
Houwing
R
et al
.
Impact of hidradenitis suppurativa on work productivity and associated risk factors
.
J Am Acad Dermatol
.
2021
;
84
(
5
):
1401
5
.
7.
Schneider-Burrus
S
,
Kalus
S
,
Fritz
B
,
Wolk
K
,
Gomis-Kleindienst
S
,
Sabat
R
.
The impact of hidradenitis suppurativa on professional life
.
Br J Dermatol
.
2022
;
188
(
1
):
122
30
.
8.
Vargas
G
,
Strassnig
M
,
Sabbag
S
,
Gould
F
,
Durand
D
,
Stone
L
et al
.
The course of vocational functioning in patients with schizophrenia: Re-examining social drift
.
Schizophr Res Cogn
.
2014
;
1
(
1
):
e41
6
.
9.
O’Donoghue
B
,
Lyne
JP
,
Fanning
F
,
Kinsella
A
,
Lane
A
,
Turner
N
et al
.
Social class mobility in first episode psychosis and the association with depression, hopelessness and suicidality
.
Schizophr Res
.
2014
157
1–3
8
11
.
10.
Warren
RB
,
Kleyn
CE
,
Gulliver
WP
.
Cumulative life course impairment in psoriasis: patient perception of disease-related impairment throughout the life course
.
Br J Dermatol
.
2011
164
Suppl 1
1
14
.
11.
von Stülpnagel
CC
,
Augustin
M
,
Düpmann
L
,
da Silva
N
,
Sommer
R
.
Mapping risk factors for cumulative life course impairment in patients with chronic skin diseases: a systematic review
.
J Eur Acad Dermatol Venereol
.
2021
;
35
(
11
):
2166
84
.
12.
USCB
S1501: educational attainment
.
United States Census Bureau
.
2020
.
13.
BLS
Civilian Unemployment rate
.
United States Bureau of Labor Statistics
.
2022
.
14.
SSA
Annual statistical report on the social security disability insurance program, 2019
.
Social Security Administration
.
2020
.
15.
CSO
Census 2016: Profile 10 – education skills and the Irish language
.
Central Statistics Office
.
2016
.
16.
CSO
Census 2016: Summary results part 1
.
Central Statistics Office
.
2016
.
17.
CSO
Labour market release archive 2022
.
Central Statistics Office
.
2022
.
18.
CSO
Illness Benefits: employment and commuting analysis 2016–2017
.
Central Statistics Office
.
2020
.
19.
Gov.uk
Highest qualification for adults aged 19–64. Education and training statistics for the UK
.
2021
.
20.
Gov.uk
Apprenticeships, 14 to 19 education and training for work
.
Education and learning
.
21.
ONS
Unemployment rate (aged 16 and over, seasonally adjusted): %
.
Office of National Statistics
.
2022
.
22.
Kirk-Wade
E
UK disability statistics: prevalence and life experiences
.
House of Commons Library
.
2022
.
23.
NISRA
Northern Ireland Benefits statistics summary February 2022
.
Professional Services Unit (Department for Communities)
.
2022
.
24.
ONS
LFS: Unemployment rate: UK: all: aged 25–49: %: SA
.
Office of National Statistics
.
2022
.
25.
Singh-Manoux
A
,
Adler
NE
,
Marmot
MG
.
Subjective social status: its determinants and its association with measures of ill-health in the Whitehall II study
.
Soc Sci Med
.
2003
;
56
(
6
):
1321
33
.
26.
Ludeke
SG
,
Gensowski
M
,
Junge
SY
,
Kirkpatrick
RM
,
John
OP
,
Andersen
SC
.
Does parental education influence child educational outcomes? A developmental analysis in a full-population sample and adoptee design
.
J Pers Soc Psychol
.
2021
;
120
(
4
):
1074
90
.
27.
Organisation for Economic Co-operation and Development
How does education affect employment rates
.
2012
.
28.
Ben-Shlomo
Y
,
Kuh
D
.
A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives
.
Int J Epidemiol
.
2002
;
31
(
2
):
285
93
.
29.
Naik
HB
,
Paul
M
,
Cohen
SR
,
Alavi
A
,
Suàrez-Fariñas
M
,
Lowes
MA
.
Distribution of self-reported hidradenitis suppurativa age at onset
.
JAMA Dermatol
.
2019
;
155
(
8
):
971
3
.
30.
Vanlaerhoven
AMJD
,
Ardon
CB
,
van Straalen
KR
,
Vossen
ARJV
,
Prens
EP
,
van der Zee
HH
.
Hurley III hidradenitis suppurativa has an aggressive disease course
.
Dermatology
.
2018
234
5–6
232
3
.
31.
Kimball
AB
,
Gieler
U
,
Linder
D
,
Sampogna
F
,
Warren
RB
,
Augustin
M
.
Psoriasis: is the impairment to a patient’s life cumulative
.
J Eur Acad Dermatol Venereol
.
2010
;
24
(
9
):
989
1004
.
32.
Bhatti
ZU
,
Salek
MS
,
Finlay
AY
.
Major life changing decisions and cumulative life course impairment
.
J Eur Acad Dermatol Venereol
.
2011
;
25
(
2
):
245
6
; author reply 6.
33.
Prens
LM
,
Bouwman
K
,
Troelstra
LD
,
Prens
EP
,
Alizadeh
BZ
,
Horváth
B
.
New insights in hidradenitis suppurativa from a population-based Dutch cohort: prevalence, smoking behaviour, socioeconomic status and comorbidities
.
Br J Dermatol
.
2022
;
186
(
5
):
814
22
.
34.
Garg
A
,
Malviya
N
,
Strunk
A
,
Wright
S
,
Alavi
A
,
Alhusayen
R
et al
.
Comorbidity screening in hidradenitis suppurativa: evidence-based recommendations from the US and Canadian hidradenitis suppurativa foundations
.
J Am Acad Dermatol
.
2022
;
86
(
5
):
1092
101
.
35.
Moritmore
AM
,
Bullen
A
,
McMeniman
EK
.
The impact of hidradenitis suppurativa on quality of life is worse than inflammatory bowel disease and myocardial infarction
.
Australas J Dermatol
.
2022
;
63
(
4
):
505
508
.
36.
Vinding
GR
,
Knudsen
KM
,
Ellervik
C
,
Olesen
AB
,
Jemec
GB
.
Self-reported skin morbidities and health-related quality of life: a population-based nested case-control study
.
Dermatology
.
2014
;
228
(
3
):
261
8
.
37.
Jørgensen
AHR
,
Holm
JG
,
Ghazanfar
MN
,
Yao
Y
,
Ring
HC
,
Thomsen
SF
.
Factors affecting quality of life in patients with hidradenitis suppurativa
.
Arch Dermatol Res
.
2020
;
312
(
6
):
427
36
.
38.
Gergely
LH
,
Gáspár
K
,
Brodszky
V
,
Kinyó
Á
,
Szegedi
A
,
Remenyik
É
et al
.
Validity of EQ-5D-5L, Skindex-16, DLQI and DLQI-R in patients with hidradenitis suppurativa
.
J Eur Acad Dermatol Venereol
.
2020
;
34
(
11
):
2584
92
.
39.
Keary
E
,
Hevey
D
,
Tobin
AM
.
A qualitative analysis of psychological distress in hidradenitis suppurativa
.
Br J Dermatol
.
2020
;
182
(
2
):
342
7
.
40.
Howells
L
,
Lancaster
N
,
McPhee
M
,
Bundy
C
,
Ingram
JR
,
Leighton
P
et al
.
Thematic synthesis of the experiences of people with hidradenitis suppurativa: a systematic review
.
Br J Dermatol
.
2021
;
185
(
5
):
921
34
.
41.
Kirby
JS
,
Sisic
M
,
Tan
J
.
Exploring coping strategies for patients with hidradenitis suppurativa
.
JAMA Dermatol
.
2016
;
152
(
10
):
1166
7
.
42.
Kirby
JS
,
Butt
M
,
Esmann
S
,
Jemec
GBE
.
Association of resilience with depression and health-related quality of life for patients with hidradenitis suppurativa
.
JAMA Dermatol
.
2017
;
153
(
12
):
1263
9
.