Pyoderma Gangrenosum is Associated with Low Socioeconomic Status: A Single-Site, Cross-Sectional Study

Background: Pyoderma gangrenosum (PG) is an uncommon, non-infectious, inflammatory skin disorder affecting individuals of all ages. Research characterizing socioeconomic status (SES) of this patient population is limited. Understanding the SES of a patient population is vital to providing a personalized approach for disease management that addresses potential barriers including transportation, work flexibility, cost of medications, and wound care. Objective: Determine if socioeconomic status and healthcare insurance coverage differs between patients with PG and other dermatology or healthcare system patient populations. Methods: A single-institution retrospective study of 255 adults with a history of PG, diagnosed between January 1, 2010 and January 1, 2020 was conducted. PG patients were compared to the following age and sex-matched cohorts: 1) Any dermatology patients without PG, 2) Psoriasis patients, 3) Atopic dermatitis patients, 4) Skin cancer patients, and 5) Any healthcare system patients. Demographic and insurance data were collected. SES was determined based on a previously validated algorithm utilizing primary residence zip code. Results: Approximately 33% of patients with PG had very low SES, defined by SES index scores in the lowest two gross income deciles, compared to 20% among the general healthcare system patient population. Medicare was the most common primary insurance at 47% of PG cohort. Medicaid was the primary insurance in 14% of PG patients. Uninsured patients comprised 11% of the PG cohort compared to 7.6% of dermatology patients and 4% of the general healthcare system patient population. Limitations: As a single-site study, results may vary based on practice type and geographic location. Conclusions: Patients with PG have lower SES and are more likely to have government insurance or no insurance than other medical and dermatology patient populations. Physicians should recognize additional barriers these patients may face in the treatment of a condition that can be difficult to manage.