{"doi":"10.1111/iwj.14388","title":"Pyoderma gangrenosum in underrepresented patient populations: An All of Us database analysis","abstract":"Pyoderma gangrenosum (PG) is a rare ulcerative disorder affecting nearly 3–10 patients per million yearly and is associated with high morbidity.1 Epidemiology studies investigating PG in patients historically underrepresented in medicine may give further information regarding disease pathophysiology and may aid in the identification of ‘at-risk’ populations. The aim of this study is to elucidate patterns of PG diagnoses in populations that have been historically underrepresented in biomedical research. Participants of the ‘All of Us’ (AoU) registered tier version 7 database were stratified based on PG diagnosis (SNOMED 133283) and the characteristics of the patients populations were compared with non-PG patients using Pearson's chi-squared tests (or Fisher's exact test if low n). Adjusted odds ratios for PG diagnoses were calculated using multivariate logistic regression. Various demographic factors including race/ethnicity, age, gender identity, etc. and selected comorbidities of PG were also evaluated (Tables 1 and 2). There were 165 PG patients out of 266 612 total patients with electronic health record (EHR) data (overall prevalence 0.05%, 95% confidence interval [CI] 0.005–0.007). PG was more prevalent in lower income brackets (odds ratio [OR] 1.63, 95% CI 1.08–2.47), unemployed (OR 2.00, 95% CI 1.34–2.98), females (1.51, 95% CI 1.07–2.13), and Hispanic/Latinx (OR 2.25, 95% CI 1.09–4.65) populations (Table 1). There was no relationship between PG and age, LGBTQ identity, education, and health insurance status. Therewas a higher rate of all comorbidities assessed in PG including gastrointestinal diseases, arthritis, cardiovascular diseases, and psychiatric illness (p < 0.001) (Table 2). There was a much higher prevalence of arthritis, hypertension, obesity, and type 2 diabetes mellitus in PG patients (p < 0.001). PG has been associated with lower socio-economic status (SES), and our findings indicate a higher risk of PG among patients with low income, unemployment, and disability. Similar to other studies, we find higher odds of PG in females; however, we also find higher odds in Hispanic/Latinx populations. This may be another manifestation of lower SES, as Hispanics comprise a significantly lower socio-economic status compared with non-Hispanic Whites.2 Social determinants of health, such as access to care, income, education, and health insurance, amplify both the burden of disease and healthcare costs.3 As PG is a diagnosis of exclusion, misdiagnosis potentiates unnecessary management, leading to longer time to resolution and increases in medical costs.4 These findings may aid in future studies elucidating the pathophysiology of disease and identification of vulnerable patients. Low SES is also linked with a higher rate of cardiovascular disease, and we report higher rates of hypertension, heart disease, and atrial fibrillation in PG patients. Given the disease burden and disability of PG, depression is more commonly reported in PG patients than in the general population. Our study presents the first evidence of a higher prevalence of anxiety and insomnia in PG patients compared with non-PG controls.5 Limitations of the present study include being dependent on EHRs, which may introduce selection bias, misclassification bias, or confounding by indication, leading to decreased generalizability of these findings. However, the size and diversity of the AoU cohort is an important strength. Increased rates of PG in patients with medical comorbidities may delay diagnosis, thus clinicians should be mindful of underdiagnosis in these populations. In light of this, dermatologists are encouraged to adopt an interdisciplinary approach. Collaborating with general practitioners and social workers can be particularly beneficial for patients with PG who are of low SES and/or unemployed. The All of Us Research Program is supported by the National Institutes of Health, Office of the Director: Regional Medical Centers: 1 OT2 OD026549; 1 O","journal":"International Wound Journal","year":2023,"id":379844,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9657,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1144982,"name":"Suraj S. Pathak","orcid":null,"position":1,"is_corresponding":false},{"id":1144983,"name":"Thu M. Truong","orcid":null,"position":2,"is_corresponding":false},{"id":1144511,"name":"Isabella Tan","orcid":"0000-0003-3123-6190","position":3,"is_corresponding":false},{"id":724461,"name":"Babar Rao","orcid":"0000-0002-9638-1279","position":4,"is_corresponding":false},{"id":1144981,"name":"Gaurav N. Pathak","orcid":null,"position":0,"is_corresponding":true}],"reference_count":6,"raw_metadata":null,"created_at":"2026-07-19T01:16:56.650289Z","pmid":"37699866","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}