Age, sex, socioeconomics tied to localized scleroderma risk: Study

Finding suggest factors may limit diagnostic access, influence exposures
by Andrea Lobo, PhD | April 29, 2025

People older than 65 and women are more likely to develop localized scleroderma, a study in the U.S. shows.The risk is lower in African Americans.
A higher risk of the disease was also seen in people who are unemployed, whereas those with less educational achievements, those whoo have less than a high school education, and lower income were at a reduced risk.

“Ultimately, our findings advocate for clinicians to integrate demographic factors such as gender, race, and socioeconomic status into their approach to [localized scleroderma] diagnosis and management,” the researchers wrote. The study, “Socioeconomic factors associated with the development of localized scleroderma: a cross-sectional study,” was published as a letter to the editor in the Archives of Dermatological Research.

Scleroderma is an autoimmune disease that affects the skin and connective tissue, which supports and holds organs together. The hallmark symptom is the accumulation of thick and hardened skin caused by excessive production of collagen, the main component of scar tissue. Localized scleroderma most often affects the skin and muscles, and rarely affects the internal organs.
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Researchers at the Rutgers Robert Wood Johnson Medical School in New Brunswick analyzed the electronic health records of people enrolled in the All of Us database to better understand the patterns of a localized scleroderma diagnosis in underrepresented patient populations.

​Risk of developing scleroderma
Of about 287,000 participants with available data, 1,074 had localized scleroderma, a prevalence of 0.37%, or 374.2 cases per 100,000 patients, which is “significantly greater than previous estimates,” the researchers wrote.

People with localized scleroderma were more commonly white (69.3% vs. 52.3%) and less commonly Black or African American (9% vs. 20%). The proportion of people older than 65 was higher in the localized scleroderma group (62.4% vs. 31%), as were the proportions of females (88.5% vs. 59.6%), college graduates or people with an advanced degree (54.3% vs. 41.9%), and the unemployed (57.5% vs. 47.7%).

This corresponded to a risk of developing the disease that was 3.4 times higher in people older than 65 years, 2.3 times higher in females, and 36% higher among unemployed people.

Black or African American people had a 59% lower risk of developing the disease relative to white people, while those with lower educational achievements or with less than high school education had a 37% and 31% lower risk. The risk of having the condition was 48% lower in people with an income below $25,000 than in those with higher income.

“These findings align with hypotheses suggesting that lower socioeconomic status, as measured by proxies such as educational attainment, may limit access to diagnostic care or influence exposure to environmental triggers,” the researchers wrote.

There was no association between localized scleroderma and ethnicity, sexual orientation, health insurance, and ability to perform activities of daily living. Likewise, the results showed no relation between the disease and hearing and vision loss.
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While localized scleroderma may cause physical impairments, the lack of significant differences in activities of daily living compared with participants without the disease “suggests that disease severity or duration, rather than mere presence, may be more predictive of functional impairments.”