Socioeconomic Status and Stroke Risk in Pediatric Sickle Cell Disease: A DISPLACE Study Secondary Analysis

Area of Science:

• Pediatric Hematology
• Neurology
• Public Health

Background:

• Transcranial Doppler (TCD) screening identifies stroke risk in children with sickle cell disease (SCD).
• Socioeconomic status (SES) may influence healthcare access and TCD results, but this link is not well-established.
• Previous research indicates barriers for public insurance households in low opportunity neighborhoods.

Purpose of the Study:

• To investigate the association between socioeconomic status (SES) and Transcranial Doppler (TCD) screening results in children with sickle cell disease (SCD).
• To identify factors influencing abnormal or conditional TCD results in pediatric SCD patients.

Main Methods:

• Secondary analysis of the DISPLACE study data (children aged 2-6 years).
• Utilized insurance type and Childhood Opportunity Index (COI) to represent household and neighborhood SES.
• Examined the association between SES proxies and TCD screening outcomes.

Main Results:

• The study included 3124 children; 41.5% lived in Very Low COI neighborhoods, and 64.6% had public insurance.
• Lack of hydroxyurea (HU) prescription was strongly associated with abnormal TCD results (aOR = 19.01, p < 0.001).
• Low SES proxies were not independently associated with abnormal or conditional TCD results.

Conclusions:

• Hydroxyurea (HU) prescription is the most significant factor associated with abnormal TCD outcomes in children with SCD.
• Socioeconomic status did not independently predict abnormal TCD results.
• Further qualitative research is needed to understand barriers to HU prescription in pediatric SCD care.