Abstract
Background
Sickle cell disease (SCD) is a rare, inherited blood disorder that predominantly affects Black and Hispanic communities in the US. Transportation insecurity, defined as the lack of resources necessary to go from place to place, is an adverse social determinant of health that disproportionately impacts marginalized communities. Transportation insecurity may further impact access to health care among individuals living with chronic illnesses such as SCD, as this population requires more frequent hospital visits and complex care management. Little is known about transportation availability among children and young adults living with SCD.Objective
To examine parent and self-reported availability of transportation to medical appointments among children and young adults living with SCD in Michigan.Methods
In partnership with the Michigan Department of Health and Human Services, the Sickle Cell Disease Association of America-Michigan Chapter created Health Status Assessments (HSA) to collect self-reported information regarding barriers and facilitators to chronic disease management among individuals living with SCD in Michigan. Patient advocates recruited participants and administered the questionnaires in-person (home or clinic) and by phone. HSAs were answered by parents for children < 18 yr and self-reported by individuals ≥ 18 yr. The study population included individuals < 25 yr with a completed HSA from 2013-2021. The HSA included questions evaluating transportation insecurity, such as the availability of transportation (yes/no), owning a personal vehicle, and sources of transportation used to travel to medical appointments and during medical emergencies (personal vehicle, rides from family/friends, transportation service, bus, taxi, walk). Survey participants were allowed to select multiple sources of transportation. The proportion of individuals that answered yes, no, or sometimes to having adequate transportation to medical appointments was assessed, overall and stratified by age (0-6, 7-12, 13-17, and 18-24 yr). A chi-square analysis was performed to observe the relationship between age and sex, and access to transportation for medical appointments. Further, the type of transportation used to travel to medical appointments and emergencies was stratified by availability of adequate transportation (yes/no).Results
The study population consisted of 758 individuals, with 50% female (n=378) and mean age 10.2 (SD=7.4). 74% reported “Yes”, 24% reported “No”, and 3% reported “Sometimes” to having adequate transportation for medical appointments. There was a statistically significant association between age and access to transportation (p<0.001), with a higher percentage of the 18-24 yr group not having adequate access to transportation. Among participants with adequate transportation, 97% reported having a personal vehicle. Within the subset of participants that reported not having access to adequate transportation, 85% of participants reported getting “rides from family and friends” and 69% reported using public forms of transportation for medical appointments (Figure). In the case of a medical emergency, 96% of participants with adequate transportation reported using their own car to travel, whereas 89% of participants without access to adequate transportation reported getting “rides from family and friends.”Conclusion
In children and young adults with SCD in Michigan, 1 in 4 reported transportation insecurity for medical appointments, highlighting the need to address barriers to transportation for people with SCD. Further research should explore the impact of transportation insecurity with outpatient and acute care utilization among this population. Medicaid policies which prioritize reimbursement for travel, such as the Medicaid Transportation Coverage Guide (September 2023) should be leveraged to help improve the accessibility of transportation for this vulnerable population.Categories: Conference Abstracts/Posters