Social determinants of health continue to lead to health disparities in patients with sickle cell disease. Socioeconomic status, neighborhood and community culture, and healthcare access all impact health outcomes, but clinicians can leverage this knowledge to make informed decisions with their patients.
Social determinants of health (SDoH) are the environmental factors affecting a person’s wellbeing. Sickle cell disease (SCD) most commonly affects people of African descent, who often face distinct challenges as a historically minoritized group in America. Therefore, understanding the complex social factors influencing patients, their behaviors, and their outcomes will help improve how the healthcare system cares for patients with SCD.
In their scoping review, Hamda Khan and colleagues identified the major SDoH affecting quality of life for patients with SCD. The most prominent determinants were neighborhood and built environment, healthcare access and literacy, social circumstances, and food and housing insecurity. Importantly, determinants do not exist in isolation, and quality of life is a culmination of disease-related conditions in conjunction with all features of the social environment.
Healthcare providers suggest that patients limit their environmental risk factors to manage SCD symptoms. However, SDoH preclude some patients from making the recommended lifestyle changes. For example, SCD symptoms worsen with temperature fluctuations, exposure to seasonal viruses, and low air quality. Unsurprisingly, patients living in polluted urban communities and areas with seasonal temperature changes experience more severe symptoms and make more hospital visits. When SCD patients need treatment, they often experience delays because they live too far from treatment centers or have limited transportation options. Discrimination and disease-related stigma present additional barriers to treatment, and patients who experienced stigma reported more severe pain and longer hospital visits.
Because SDoH contribute to health disparities in Black and African American patients, healthcare professionals must integrate their awareness of SDoH into their practices. Actionable steps for hospitals include expanding cultural competency training for providers, diversifying the pool of clinical trial participants, and bringing people from minority backgrounds into the healthcare workforce to improve the quality of healthcare for minority patients.
Khan, H., Krull, M., Hankins, J. S., Wang, W. C., & Porter, J. S. (2022). Sickle cell disease and social determinants of health: A scoping review. Pediatric Blood & Cancer, e30089. https://doi.org/10.1002/pbc.30089