Background & Aims
Sickle cell disease (SCD) is a genetic disorder of the blood and the most common disease detected during newborn screening, which leads to severe morbidity and early mortality. Patients experience severe episodic and chronic pain which contributes to acute care visits and hospitalizations. Less understood is the influence of social and physical characteristics of where adults with SCD live.
Aims: To examine the associations of neighborhood residential racial segregation and SES (Index of Concentration at the Extreme (ICE) value which includes income disparity), neighborhood healthcare resources (number of available primary care providers, number of pharmacies) with (1) prescribed daily pain medication use. (2) acute care visits (emergency department, infusion center) and (3) acuity (hospital admissions).
Methods
The study merged individual-level data from Examining Sickle Cell Acute Pain in the Emergency vs Day Hospital study participants in Baltimore, Cleveland, Milwaukee and Baton Rouge with neighborhood-level data (Lanzkron, Little, Field, Shows, et al., 2018; Lanzkron, Little, Field, Haywood Jr, et al., 2018). Mixed-effects Poisson models were used to account for random effects within individuals and to account for potential correlation within zip codes (n=482). Models adjusted for age, current hydroxyurea use, disability status, employment status, gender, hematologist and primary care provider status, education attainment, income, SCD genotype, residential status, health insurance type, and whether they experience daily chronic pain.
Results
Preliminary results. Residing in a neighborhood with more pharmacies (IRR=5.454, 95% CI: 1.257, 23.660) and more transit stops (IRR=0.886, 95% CI: 0.822, 0.955) were associated with more and less medication adjustments respectively. Neighborhood residential segregation (IRR=0.639, 95% CI: 0.470, 0.870) and neighborhood distance to the study site (IRR=0.982, 95% CI: .0.973, 0.990) were associated with fewer acute care visits and neighborhood transit stops associated with more (IRR=1.060, 95% CI: 1.000, 1.123) . Neighborhood distance to the study site (IRR=0.992, 95% CI: 0.985, 1.000) was associated less admissions.
Conclusions
Preliminary conclusions. The data suggests that residential segregation deserve additional study within the context of land use and urban development. Further analysis is required to determine if increased medication adjustments’ association with greater number of pharmacies enables appropriate care utilization or if an unexplored dynamic is at play. Greater attention should be paid to the neighborhood environments in which people live their daily lives.
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Presenting Author
Rhonda Smith Wright
Poster Authors
Rhonda Smith Wright
MHSA, MSN, RN
Johns Hopkins University
Lead Author
Topics
- Racial/Ethnic/Economic Differences/Disparities