Objective Few studies have estimated the healthcare resource usage of patients with systemic sclerosis (SSc). The purpose of this study was to compare hospitalization among incident cases of SSc vs age- and sex-matched comparators. Methods A retrospective, population-based cohort of patients with SSc in Olmsted County, MN from Jan 1, 1980 to Dec 31, 2016 was assembled. A 2:1 cohort of age- and sex-matched patients without SSc from the same population was randomly selected for comparison. All hospitalizations in the geographic area from Jan. 1, 1987 to Sept. 30, 2018 were obtained. Rates of hospitalization, lengths of stay, and readmissions were compared between groups. Results 76 incident SSc cases and 155 non-SSc comparators (mean age of 56 ± 16 years at diagnosis/index, 91% female) were included. Rates of hospitalization among cases and comparators were 31.9 and 17.9 per 100 person-years, respectively (rate ratio [RR]:1.78; 95% confidence interval (CI):1.52-2.08). Hospitalization rates were higher in patients with SSc than comparators during the first 5 years after SSc diagnosis (RR: 2.16; 95%CI: 1.70-2.74). This difference decreased over time and was no longer significant at ≥15 years after SSc incidence/index. Lengths of stay (median (IQR) 4 (2-6) vs 3(2-6); p=0.52) and readmission rates (25% vs 23%; p=0.51) were similar between groups. Conclusion Patients with SSc were hospitalized more frequently than comparators, indicating high inpatient care needs in this population. Hospitalization rates were highest during the first 5 years following SSc diagnosis.