Preschool children with sickle cell disease (SCD) living in food deserts and with limited transportation experience acute complications despite receiving free evidence-based treatment and social support. A new study has found that there is an increased risk of hospitalization and hospitalization. The results were published today in the journal Blood Advances.
“Despite the level of care that families and patients receive in our clinics, there are still gaps in being able to address the barriers they experience within their communities,” said the study’s senior author. said Dr. Jason Hodges. Director of Research and Clinical Studies in the Department of Hematology at St. Jude Children’s Research Hospital in Memphis.
We need to think about the region and context from which these patients and families are coming. Because it has a big impact on your health. ”
Jason Hodges, Director of Research and Clinical Studies, Division of Hematology, St. Jude Children’s Research Hospital
Previous research has shown that social determinants of health (SDoH), the conditions in which people are born, grow, work, live, and learn, can influence the health of children with SCD. However, less is known about how regional-level factors influence this. Transportation access, income level, educational background, and proximity to grocery stores may contribute to health disparities among these patients.
For this study, Dr. Hodges and his team wanted to examine SDoH at a specific regional level in more detail. For example, a household’s distance from a grocery store, number of children in the household, car ownership, neighborhood income, and parental education level. – Assess whether these factors are associated with increased acute care (ACU) utilization, including emergency department visits and hospitalizations, in preschool children with SCD.
Researchers enrolled 435 children aged 0 to 6 years (median 5.7 demographic, treatment, and ACU data were analyzed. People who live with SCD throughout their lives. Participants’ home addresses were mapped and grouped by census tract and compared to census-level data on household poverty levels and food access from the U.S. Department of Agriculture’s Food Access Survey Atlas.
All participants were black. Half (52%) were female and just over half (60%) of the participants had a severe SCD genotype (HbSS/HbSb0 thalassemia). Forty-three percent of patients lived in areas identified by the U.S. Census as particularly vulnerable to hardship. All participants received standard medical care, hydroxyurea and/or monthly blood transfusions as needed, as well as social support such as transportation and meal services when arriving at their appointment. Ta.
After controlling for sickle SCD genotype and disease-modifying therapy, the research team found that living in a household more than 1 mile from a supermarket was associated with a 44% increase in hospitalizations for children with SCD aged 0 and ACU found that it was associated with a 37% increase in -6 years. Children under the age of 6 were significantly more likely to be hospitalized if they lived more than a mile from a grocery store and did not have a car. Conversely, children with SCD were 33% less likely to experience ACU and hospitalization, respectively, in households with an adult with at least one bachelor’s degree (11.7%), suggesting that parental education level may have a protective effect. It is suggested that there is.
“The data suggest that no matter how much care we provide to patients with chronic diseases like SCD, and no matter how many new treatments we have, we still have problems with food deserts and the quality of life of our neighbors. If we don’t start addressing the deep-seated issues, it’s always going to be very difficult, from a perspective, to provide comprehensive care to our patient population,” said study lead author and St. Jude Children’s Research Hospital Department of Hematology. said Hamda Khan, MSc, clinical researcher at .
Khan and Hodges believe that these data on the effects of neighborhood and other community-level SDoH on the health of SCD patients will inform public policy to bring more resources and public health interventions to these high-need areas. We hope that it will be useful in the formation of They argue that further research should focus on household size, medical maintenance visits, and environmental hazards such as air pollution to better understand the impact of environmental SDoH on this patient population. There is.
The authors note that this study is specific to SCD patients aged 0 to 6 years who received comprehensive care and social support, and is unique to older SCD patients and those who have immigrated to areas with better access to resources. He cautioned that it may not reflect his experience. or those who do not receive support services. Further limitations may include insufficient data on adherence to disease-modifying therapy.
SCD is the most common inherited blood cell disease in the United States, affecting an estimated 100,000 people and 1 in 365 black or African American births. SCD is characterized by misshapen red blood cells that can block blood vessels, causing tissue and organ damage as well as episodes of severe pain.
sauce:
American Society of Hematology
Reference magazines:
Kahn, H., et al. (2024) Social determinants of health influence disease severity in preschool children with sickle cell disease. Blood progresses. doi.org/10.1182/bloodadvances.2023012379.
