Patients with sickle cell disease (SCD) experience socioeconomic disadvantages and utilize healthcare services at a markedly higher rate. The area deprivation index (ADI), a method for quantifying socioeconomic disadvantage, has been correlated with increased hospital readmission in adults and children with chronic disease. This retrospective study, published in Blood, analyzes the role of ADI in pediatric patients with SCD that were admitted due to vaso-occlusive events.
Data were gathered from 675 consecutive emergency department and hospital admissions for vaso-occlusive events among 101 pediatric patients with SCD from 2016 to 2019 at a single urban, U.S.-based medical center. The researchers extracted demographic information as well as SCD characteristics, admission complications, management characteristics, entry and discharge pain scores, length of stay, and readmission rates. Data analysis was performed using logistic regression.
Ultimately, it was found that the less disadvantaged group had the same number of patients on public and private insurance, while the more disadvantaged group showed an 83.3% rate of public insurance use. The Hb SC genotype, mental health disease, and hospital complications were also more common in the more disadvantaged group.
Moreover, both groups had high numbers of prescriptions for hydroxyurea and opiates, with the less disadvantaged group having slightly higher numbers. Finally, pain scores and length of stay were similar across groups, while readmission, scheduled follow-up, and shorter time to follow-up were more common for the more disadvantaged group. No correlation was found between hospital readmission and ADI score (based on zip code).
The researchers concluded that the medical home model of managing SCD is beneficial in overcoming ADI to improve pediatric SCD outcomes. More research is needed in this area to identify additional protective factors that may reduce acute care utilization and social disparity for this population .
Source: Goldenberg, M., McCormick, M., Ruppert, K., Novelli, E. M., & Kalpatthi, R. (2021). Vaso-occlusive events in pediatric sickle cell disease: quantifying social disadvantage and its impact on hospitalizations. Blood, 138(Supplement 1), 1949. https://doi.org/10.1182/blood-2021-153986