Indiana University School of Medicine, Indianapolis, Indiana, USA.
Division of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Pediatr Blood Cancer. 2025 Jan;72(1):e31422. doi: 10.1002/pbc.31422. Epub 2024 Nov 6.
Individuals with sickle cell disease (SCD) experience significant healthcare disparities; however, there is little known on the impact of psychosocial stressors and neighborhood disadvantage on preventive and acute care utilization in this population.
A retrospective data collection was performed for all patients cared for at a comprehensive pediatric sickle cell center in the Midwest who had also completed the Psychosocial Assessment Tool (PAT), a validated caregiver-reported measurement of family psychosocial risk, from September 2021 through December 2022. Patient age, payor, primary language, frequency of acute and missed preventive care visits, as well as Area Deprivation Index (ADI) and Childhood Opportunity Index (COI) scores were collected for 256 patients.
The average state ADI was 6.3 (±2.9), and the majority of patients were in the Very Low or Low COI categories. Total PAT score (p = 0.003), state ADI (p < 0.001), and state COI (p < 0.001) were all significantly correlated with missed SCD clinic visits, with increased odds of a missed visit with increasing neighborhood disadvantage (OR 1.22, p < 0.001). The odds of acute care were also increased in those with higher family psychosocial risk (OR 1.76, p < 0.011), though this was not seen with ADI or COI, suggesting an additional effect of family stressors and resilience on acute care utilization.
This highlights the importance of regular, universal social and psychological risk screening, as well as inclusion of psychosocial team members in SCD programs to identify and readily address risk factors that impact child outcomes in a minoritized chronic disease population.
镰状细胞病（SCD）患者存在显著的医疗保健差异；然而，人们对心理社会压力源和邻里劣势对该人群预防和急性护理利用的影响知之甚少。
对 2021 年 9 月至 2022 年 12 月期间在中西部一家综合性儿科镰状细胞中心接受治疗且完成了心理社会评估工具（PAT）的所有患者进行了回顾性数据收集，PAT 是一种经过验证的、由照顾者报告的家庭心理社会风险测量工具。收集了 256 名患者的年龄、付款人、主要语言、急性和错过预防保健就诊的频率，以及区域贫困指数（ADI）和儿童机会指数（COI）评分。
平均州 ADI 为 6.3（±2.9），大多数患者处于非常低或低 COI 类别。总 PAT 评分（p=0.003）、州 ADI（p<0.001）和州 COI（p<0.001）与 SCD 诊所就诊次数均显著相关，邻里劣势增加与错过就诊次数的可能性增加（OR 1.22，p<0.001）。具有较高家庭心理社会风险的患者（OR 1.76，p<0.011），急诊就诊的可能性也增加，但 ADI 或 COI 未见此情况，这表明家庭压力源和适应力对急性护理利用有额外影响。
这突出表明，需要定期、普遍进行社会和心理风险筛查，并让心理社会团队成员参与 SCD 计划，以识别和迅速解决影响少数族裔慢性疾病人群儿童结局的风险因素。
