Neighborhood socioeconomic opportunity and clinical presentation, recurrence, and longitudinal treatment intensity in adolescent pilonidal disease.
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BACKGROUND: Pilonidal disease is a chronic inflammatory condition of adolescence requiring sustained outpatient management, yet the impact of neighborhood-level social determinants of health on disease course and treatment intensity remains unclear. METHOD: We conducted a retrospective cohort study of adolescents evaluated for pilonidal disease at a high-volume specialty clinic from 2019 to 2024. Residential addresses were geocoded and linked to census tract-level socioeconomic opportunity using the California Healthy Places Index (HPI). HPI was analyzed continuously, by quintiles, and using a prespecified lowest-quintile (Q1) threshold contrast. Outcomes included disease stage at presentation, symptom duration, recurrence, receipt of laser epilation, and number of completed laser sessions. Multivariable models adjusted for age and sex; treatment intensity models additionally adjusted for stage and recurrence. RESULTS: Among 393 adolescents (median age 17.0 years[IQR:15.3-18.8]), neighborhood opportunity was not associated with disease severity, symptom duration, recurrence, or receipt of laser therapy. However, among laser recipients (92%), Q1 residence was independently associated with fewer completed laser sessions (adjusted IRR:0.78; 95% CI:0.65-0.93), reflecting approximately 22% lower treatment intensity. CONCLUSIONS: Neighborhood-level social determinants were associated with reduced continuity of ambulatory surgical care, reflected by lower longitudinal laser treatment intensity, suggesting structural influences on continuity of ambulatory surgical care rather than biologic disease trajectory.