Examining Community-Level Social Vulnerability and Emergency Department Use for People with Sickle Cell Disease in Michigan

Abstract

Background

Sickle Cell Disease (SCD) is a genetic disorder associated with morbidity, premature mortality, and frequent emergency department (ED) visits. SCD impacts underrepresented racial and ethnic groups who often experience structural racism and discrimination in the form of inequitable social circumstances.

Objective

This study aimed to examine associations between ED visits and community-level social vulnerability among people with SCD in Michigan.

Methods

The Michigan Sickle Cell Data Collection program was used to identify people in Michigan with SCD as well as their census tract and number of ED encounters in 2018. Census tract community-level vulnerabilities were measured using the CDC’s 2018 Social Vulnerability Index (SVI). A paired t-test examined associations between SVI scores for Michigan census tracts with and without known SCD residents. Associations between individual-level SVI scores and ED utilization were analyzed using zero inflated negative binomial models with clustered standard errors at the census tract level, adjusted for age and sex.

Results

The study population consisted of 2,767 people with SCD with a mean age of 28 (SD=18), 58% were female, and 82% were Black. SVI was higher among census tracts where individuals with SCD resided (mean SVI=0.69; SD=0.26) compared to tracts without individuals with SCD (mean SVI=0.40; SD=0.25; p<0.001). The average number of ED visits per person in 2018 was 3.3 (SD=10.1). No statistically significant association was found between community SVI scores and individual ED utilization.

Conclusion

People with SCD in Michigan live in census tracts with higher social vulnerability, highlighting inequities that are disproportionately faced by the Michigan SCD population.