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

BACKGROUND: Transcranial doppler (TCD) screening identifies children ages 2-16 years with sickle cell disease (SCD) at an increased risk for stroke. Previous studies have shown that individuals from households on public insurance with limited neighborhood opportunity have increased barriers to receiving adequate healthcare; however, it is unknown whether low socioeconomic status (SES) influences TCD results. METHODS: We conducted a secondary analysis of the DISPLACE study data, which included children aged 2-6 years who had at least one TCD screen performed during their year of study enrollment, if space allowed. We utilized insurance type (public insurance vs. all other insurances) and overall childhood opportunity index (COI) group (Very Low vs. all other COI levels [Low, Medium, High, and Very High]) to proxy household- and neighborhood-level SES. We then examined the association between household- and neighborhood-level SES and conditional or abnormal TCD screening results. RESULTS: The analytic cohort included 3124 children, with 1295 (41.5%) children living in Very Low COI neighborhoods and 2019 (64.6%) of households with public insurance. In the multinomial logistic regression model, only the lack of HU prescription remained significantly associated at p < 0.05 with abnormal TCD result (adjusted odds ratio = 19.01, p < 0.001). CONCLUSION: Lack of hydroxyurea (HU) prescription was the factor most strongly associated with abnormal TCD outcome. Low SES proxies were not independently associated with abnormal or conditional TCD results. Qualitative studies are needed to better understand why a child with SCD might not have been prescribed HU.