Khan Hamda, Kang Guolian, Porter Jerlym S, Ding Juan, Wang Winfred C, Estepp Jeremie H, Gurney James G, Davis Robert, Hankins Jane S, Hodges Jason R
Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN.
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN.
Blood Adv. 2024 Dec 10;8(23):6088-6096. doi: 10.1182/bloodadvances.2023012379.
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.
镰状细胞病（SCD）患者面临着管理终身慢性病的负担，这增加了他们对健康的社会决定因素（SDoH）的易感性。然而，SDoH如何导致健康差距的研究较少。我们假设，生活在社会经济困境较高的贫困社区的患有SCD的学龄前儿童，尽管接受了疾病改善治疗，但急性护理利用率（ACU；定义为急诊就诊加住院）仍会增加。使用美国农业部食品获取研究地图集的普查区环境数据对参与者（0至6岁）的家庭住址进行了绘制。在对镰状基因型和疾病改善疗法（羟基脲和慢性输血）、SDoH指标（即食物获取受限、缺乏车辆、低收入和教育不足）进行多变量分析时，这些指标与较高的ACU相关。对于患有SCD（年龄<6岁）的儿童，居住在距离超市超过1英里且有孩子的家庭中，住院率（优势比[OR]，1.44；95%置信区间[CI]，1.13 - 1.85）和ACU（OR，1.37；95% CI，1.06 - 1.80）更高。在至少有1名学士学位获得者的家庭中，患有SCD的儿童的ACU（OR，0.67；95% CI，0.50 - 0.93）和住院率（OR，0.67；95% CI，0.49 - 0.92）较低。尽管接受了免费的循证治疗和社会支持，但食物和交通获取受限的患有SCD的学龄前儿童发生急性并发症的风险更高。家庭教育水平可能具有保护作用。尽管拥挤家庭中的SDoH和医疗保健维持就诊不是本研究的重点，但未来的研究应考虑这些因素。了解SCD与SDoH之间的关联对于指导资源分配以改善受影响儿童的健康至关重要。
