High unemployment rate in patients with hidradenitis suppurativa despite high educational attainment

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 Chi-square 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 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, 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.