Social and Behavioral Factors in Sickle Cell Disease: Employment Predicts Decreased Health Care Utilization

Abstract

to determine frequency of health care encounters among people with sickle cell disease (SCD) seeking treatment for a vaso-occlusive crisis (VOC). Health care encounters are categorized by visit type (day hospital, ED visit, hospitalization), prevalence of self-reported behavioral and social factors, and any associations between behavioral and social factors and health care encounters. Ninety-five people with SCD were enrolled in a prospective descriptive study in North Carolina. Patients were interviewed concerning behavioral-social factors, and a report of health care encounters was produced, generated by ICD codes associated with VOCs between October 2011 and March 2014. Among 95 patients, there were a total of 839 day hospital and 1,990 ED visits, and 1,101 hospital admissions. Prevalent behavioral and social factors were depression (29%), anxiety (34%), illicit drug use (6%); unstable home situation (17%); and unemployment (81%). Employment and stable home were significantly associated with decreased frequency of health care encounters.

Coronavirus Disease among Persons with Sickle Cell Disease, United States, March 20–May 21, 2020

“…Persons with SCD face socioeconomic and healthcare access disparities that might compound their already high risk for severe COVID-19 because of their underlying disease and concurrent conditions. SCD complications might negatively impact educational achievement and employment (13,14). Accessing appropriate healthcare is difficult given the lack of providers with SCD expertise.…”

“…Accessing appropriate healthcare is difficult given the lack of providers with SCD expertise. SCD patients might delay seeking care, and emergency department visits are high among this population that is placed at increased risk for poor health (14).…”

The Relationship between Cognitive and Emotional Factors and Healthcare and Medication Use in People Experiencing Pain: A Systematic Review

“…Analyses investigating the relationship between depressive symptoms and the number of healthcare consultations resulted in inconsistent findings (univariate: 13 reporting a positive association [ 64 , 67 , 72 , 74 , 83 , 98 , 100 , 108 , 113 , 123 , 126 , 132 ], 1 a negative [ 61 ] and 11 no association [ 48 , 98 , 123 , 125 ]—52%; multivariate: 13 reporting a positive association [ 61 , 74 , 78 , 83 , 96 , 102 , 114 , 120 , 123 ] and 19 no association [ 25 , 48 , 50 , 64 , 67 , 71 , 72 , 100 , 102 , 108 , 113 , 117 , 125 , 126 ]—41%). Based on univariate analyses, it was unclear whether depressive symptoms were associated with emergency HCU (3 reporting a positive association [ 67 , 83 , 85 ], 1 a negative [ 125 ] and 3 no association [ 48 , 108 ]—43%) and HCU in general (2 reporting a positive association [ 48 , 135 ] and 3 no association [ 48 ,…”

“…Based on univariate analyses, it was unclear whether depressive symptoms were associated with emergency HCU (3 reporting a positive association [67,83,85], 1 a negative [125] and 3 no association [48,108]-43%) and HCU in general (2 reporting a positive association [48,135] and 3 no association [48,64,135]-40%) in people with pain; on the contrary, multivariate analyses showed absence of evidence for a relationship with both emergency HCU (1 reporting a positive association [83], 1 a negative [125] and 5 no association [67,102,117]-14%) and HCU in general (2 a positive [119,120] and 5 no association [48,57,58,135]-29%). Moreover, no evidence was found based on multivariate analyses for a relationship between depressive symptoms and amount and/or duration of hospitalizations in people having pain (1 analysis reported a positive association [83] and 8 no association [52,102,114,117,125]-11%).…”

“…Cont. Gil (2004) [102] 1 1 1 NA 1 1 1 0 0 0 0 NA NA NA 1 1 1 NA 1 1 NA NA NA NA 1 1 0 13/18 Hadlandsmyth (2013) [103] 1 1 1 NA 0 1 1 1 1 0 0 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 0 0 0 11 /18 Jordan (2006) [104] 1 1 1 NA 1 1 1 0 0 1 0 NA NA NA 1 1 1 NA 1 0 NA NA NA NA 1 0 0 12/18 Keeley (2008) [105] 1 1 1 NA 1 1 1 0 1 1 0 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 1 0 0 13/18 Kuijper (2014) [106] 1 1 NA 1 1 1 0 1 1 0 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 1 1 0 16/18 Lentz (2018) [107] 1 1 1 NA 1 1 1 1 1 1 1 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 1 1 1 17/18 Levenson (2008) [108] 1 1 1 NA 1 1 1 1 1 0 0 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 1 0 0 13/18 McCracken (2005; Pain) [109] 1 1 1 NA 1 1 1 1 0 1 1 NA NA NA 0 0 1 NA 1 1 NA NA NA NA 1 0 0 13/18 Musey (2018) [110] 1 1 1 NA 1 1 1 0 1 0 0 NA NA NA 1 0 1 NA 1 0 NA NA NA NA 1 0 1 12/18 Navabi (2018) [111] 1 1 1 NA 1 1 1 0 0 1 0 NA NA NA 1 0 1 NA 1 0 NA NA NA NA 1 0 0 11/18 Pagé (2019) [112] 0 1 1 NA 1 1 1 0 1 1 1 NA NA NA 0 0 1 NA 1 1 NA NA NA NA 1 0 0 12/18 Tremblay (2018) [113] 1 1 1 NA 1 1 1 1 1 1 0 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 1 0 0 14/18 Ullrich (2013) [114] 1 1 1 NA 1 1 1 0 0 1 1 NA NA NA 1 0 1 NA 1 0 NA NA NA NA 1 0 0 12/18 Van Tilburg (2008) [115] 1 1 1 NA 1 1 1 0 0 1 1 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 1 0 0 12/18 Vervoort (2019) [116] 1 1 1 NA 1 1 1 1 1 1 0 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 1 1 0 15/18 Williams (2018) [117] 1 1 1 NA 1 1 1 0 1 1 0 NA NA NA 1 0 1 NA 0 1 NA NA NA NA 1 0 0 12/18 Wong (2019) [118] 1 0 1 NA 1 1 0 0 0 1 0 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 0 1 0 10/18 Woodhouse (2016) [119] 1 1 1 NA 1 1 1 0 1 1 0 NA NA NA 1 0 1 NA 1 1 NA NA NA NA 1 0 0 13/18…”