Background: Hidradenitis suppurativa (HS) negatively impacts patients’ quality of work and productivity.

Objective: To determine how HS Hurley staging, Physician Global Assessment (PGA) and Severity Assessment of Hidradenitis Suppurativa (SAHS) relate to absenteeism and presenteeism in patients with HS.

Methods: We performed a single center, cross-sectional study, conducted from December 2018-April 2019. Patients were considered eligible if they were 12 years of age or older and had a clinical visit for HS. Patients were excluded if they declined to participate; were not literate in English or French or were unemployed. Severity of HS was assessed using Hurley staging system, PGA, SAHS. Absenteeism and presenteeism in the four weeks preceding the clinical encounter were evaluated by absenteeism and presenteeism modules of iMTA Productivity Cost Questionnaire (iPCQ).

Poisson regressions were used to investigate the impact of each clinical HS severity measure (VAS, PGA, SAHS or Hurley Stage) on the number of missed work days, the number of worked days with bothersome physical or psychological symptoms, and the quantity of work measured on a scale of zero to ten assessing how much work they could do while being bothered by symptoms, with zero representing ‘not able to work’ and ten representing ‘doing work normally.’

Results: For absenteeism, VAS has an overall statistically significant effect on the number of missed work days (p = 0.025) after adjusting for surgical intervention in the past 4 weeks. The expected number of absent days for 'Moderate or Severe Pain' increases by approximately 1.8 days (-1.3, 4.3) compared to days missed as a result of 'No or Mild Pain'. [Note: (-1.3, 4.3) is the 95% confidence interval]. PGA has an overall statistically significant effect on the number of missed days (p = 0.004) after adjusting for surgical intervention. Comparing to 'Clear, Minimal or Mild' PGA, the expected number of absent days for 'Moderate or Severe' PGA increases by about 1.7 days (-1.4, 4.1) and for 'Very Severe' PGA increases by about 2.6 (-1.1, 7.6). SAHS has an overall statistically significant effect on the number of missed work days (p < 0.001) after adjusting for surgical intervention. Comparing to 'Mild disease', the expected number of absent days for ' Moderate disease' increases by about 3.6 days (1.1, 11.0) and for 'Severe disease' the level increases by about 4.8 days (1.4, 16.8). Hurley stage has an overall statistically significant effect on the number of missed work days (p = 0.002) after adjusting for surgical intervention. The expected number of absent days for stage III increases by about 2.1 days (-1.0, 4.5) when compared to stages I or II.

For presenteeism, VAS has an overall statistically significant effect on the number of symptomatic worked days (p < 0.001) after adjusting for surgical intervention. The expected number of worked days bothered by 'Moderate or Severe Pain' increases by about 3.6 days (1.8,7.3) compared to 'No or Mild Pain'. PGA has an overall statistically significant effect on the number of symptomatic worked days (p < 0.001) after adjusting for surgical intervention. Comparing to 'Clear or Minimal' PGA, the expected number of days bothered for 'Mild, Moderate or Severe' PGA increases by about 1.5 days (-2.6, 5.7) and for 'Very Severe' PGA increases by about 2.4 days (-2.0, 11.1). SAHS has an overall statistically significant effect on the number of symptomatic worked days (p < 0.001) after adjusting for surgical intervention. Comparing to 'Mild disease' activity, the expected number of worked days bothered by 'Moderate disease' activity increases by about 1.6 days (-1.4, 3.5) and for 'Severe disease' activity increases by about 2.0 (-1.1, 4.5). Hurley stage has an overall statistically significant effect on the number of symptomatic worked days (p < 0.001) after adjusting for surgical intervention. Comparing to Stage I, the expected number of symptomatic worked days in Stage II patients increases by about 1.6 days (-1.5, 4.1) and in Stage III patients increases by about 2.1 days (-1.1, 5.0).

Conclusions: The clinical severity of Hidradenitis Suppurativa assessed by Hurley staging, VAS, PGA and SAHS impacts the quantity and quality of patients’ work. Presenteeism is more frequent than absenteeism; SAHS is a good clinical predictor for both outcome

Impact of Clinical Severity on Absenteeism and Presenteeism in Patients with Hidradenitis Suppurativa