Social determinants of health affect disease severity among preschool children with sickle cell disease
Abstract: Individuals with sickle cell disease (SCD) face the burden of managing a lifelong chronic illness, increasing vulnerability to social determinants of health (SDoH). However, how SDoH contributes to health disparities is understudied. We hypothesized that preschool children with SCD living...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-12-01
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| Series: | Blood Advances |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2473952924006049 |
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| author | Hamda Khan Guolian Kang Jerlym S. Porter Juan Ding Winfred C. Wang Jeremie H. Estepp James G. Gurney Robert Davis Jane S. Hankins Jason R. Hodges |
| author_facet | Hamda Khan Guolian Kang Jerlym S. Porter Juan Ding Winfred C. Wang Jeremie H. Estepp James G. Gurney Robert Davis Jane S. Hankins Jason R. Hodges |
| author_sort | Hamda Khan |
| collection | DOAJ |
| description | Abstract: Individuals with sickle cell disease (SCD) face the burden of managing a lifelong chronic illness, increasing vulnerability to social determinants of health (SDoH). However, how SDoH contributes to health disparities is understudied. We hypothesized that preschool children with SCD living in poor neighborhoods with higher socio-economic distress would experience increased acute care utilization (ACU; described as emergency department visits plus hospitalizations) despite disease-modifying therapy. Participants' home addresses (aged 0-6 years) were mapped using census tract environmental data from the US Department of Agriculture Food Access Research Atlas. In multivariable analyses controlled for sickle genotype and disease-modifying therapies (hydroxyurea and chronic transfusion), SDoH indicators, that is, limited access to food, lack of vehicle, low income, and inadequate education, were associated with higher ACU. Living in households with children >1 mile from a supermarket was associated with more hospitalizations (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.13-1.85) and ACU (OR, 1.37; 95% CI, 1.06-1.80) among children with SCD (aged <6 years). In households with at least 1 bachelor's degree, children with SCD experienced less ACU (OR, 0.67; 95% CI, 0.50-0.93) and hospitalizations (OR, 0.67; 95% CI, 0.49-0.92). Preschool children with SCD with limited access to food and transportation are at a higher risk of acute complications despite receiving free evidence-based therapy and social support. The family education level may have a protective effect. Although SDoH in crowded households and health care maintenance visits were not a focus of this study, future research should consider these factors. Understanding the SCD and SDoH association is crucial for directing resources to improve affected children's health. |
| format | Article |
| id | doaj-art-687adba7e26f4314809f02d1112f28c7 |
| institution | Kabale University |
| issn | 2473-9529 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Blood Advances |
| spelling | doaj-art-687adba7e26f4314809f02d1112f28c72024-12-04T05:13:26ZengElsevierBlood Advances2473-95292024-12-0182360886096Social determinants of health affect disease severity among preschool children with sickle cell diseaseHamda Khan0Guolian Kang1Jerlym S. Porter2Juan Ding3Winfred C. Wang4Jeremie H. Estepp5James G. Gurney6Robert Davis7Jane S. Hankins8Jason R. Hodges9Department of Hematology, St. Jude Children’s Research Hospital, Memphis, TNDepartment of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TNDepartment of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TNDepartment of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN; Department of Information and Computing Science, College of Sciences, Hohai University, Nanjing, ChinaDepartment of Hematology, St. Jude Children’s Research Hospital, Memphis, TNDepartment of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TNSchool of Public Health, The University of Memphis, Memphis, TNCenter for Bioinformatics, The University of Tennessee Health Science Center, Memphis, TNDepartment of Hematology, St. Jude Children’s Research Hospital, Memphis, TN; Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TNDepartment of Hematology, St. Jude Children’s Research Hospital, Memphis, TN; Correspondence: Jason R. Hodges, Department of Hematology, St. Jude Children’s Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105;Abstract: Individuals with sickle cell disease (SCD) face the burden of managing a lifelong chronic illness, increasing vulnerability to social determinants of health (SDoH). However, how SDoH contributes to health disparities is understudied. We hypothesized that preschool children with SCD living in poor neighborhoods with higher socio-economic distress would experience increased acute care utilization (ACU; described as emergency department visits plus hospitalizations) despite disease-modifying therapy. Participants' home addresses (aged 0-6 years) were mapped using census tract environmental data from the US Department of Agriculture Food Access Research Atlas. In multivariable analyses controlled for sickle genotype and disease-modifying therapies (hydroxyurea and chronic transfusion), SDoH indicators, that is, limited access to food, lack of vehicle, low income, and inadequate education, were associated with higher ACU. Living in households with children >1 mile from a supermarket was associated with more hospitalizations (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.13-1.85) and ACU (OR, 1.37; 95% CI, 1.06-1.80) among children with SCD (aged <6 years). In households with at least 1 bachelor's degree, children with SCD experienced less ACU (OR, 0.67; 95% CI, 0.50-0.93) and hospitalizations (OR, 0.67; 95% CI, 0.49-0.92). Preschool children with SCD with limited access to food and transportation are at a higher risk of acute complications despite receiving free evidence-based therapy and social support. The family education level may have a protective effect. Although SDoH in crowded households and health care maintenance visits were not a focus of this study, future research should consider these factors. Understanding the SCD and SDoH association is crucial for directing resources to improve affected children's health.http://www.sciencedirect.com/science/article/pii/S2473952924006049 |
| spellingShingle | Hamda Khan Guolian Kang Jerlym S. Porter Juan Ding Winfred C. Wang Jeremie H. Estepp James G. Gurney Robert Davis Jane S. Hankins Jason R. Hodges Social determinants of health affect disease severity among preschool children with sickle cell disease Blood Advances |
| title | Social determinants of health affect disease severity among preschool children with sickle cell disease |
| title_full | Social determinants of health affect disease severity among preschool children with sickle cell disease |
| title_fullStr | Social determinants of health affect disease severity among preschool children with sickle cell disease |
| title_full_unstemmed | Social determinants of health affect disease severity among preschool children with sickle cell disease |
| title_short | Social determinants of health affect disease severity among preschool children with sickle cell disease |
| title_sort | social determinants of health affect disease severity among preschool children with sickle cell disease |
| url | http://www.sciencedirect.com/science/article/pii/S2473952924006049 |
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