Abstract
Purpose
Patients with low educational attainment may be at increased risk for unplanned health care utilization. This study aimed to determine what factors are related to emergency department (ED) visits in hopes of guiding treatments and early interventions.
Methods
At two medical centers in the Mid-Atlantic United States, 258 adults with sickle cell disease aged 19–70 years participated in a retrospective study where we examined whether education level is independently associated with ED visits after accounting for other socioeconomic status (SES) variables, such as pain and disease severity and psychosocial functioning.
Results
The data showed that patients without a high school education visited the ED three times as frequently as patients with post secondary education. Controlling for poverty and employment status decreased the effect of education on ED visits by 33.24 %. Further controlling for disease severity and/or psychosocial functioning could not account for the remaining association between education and ED visits, suggesting that education is independently associated with potentially avoidable emergency care.
Conclusions
Early interventions addressing disparities in academic performance, especially for those children most at risk, may lead to improved long-term health outcomes in this population.
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References
Williams TN, Weatherall DJ. World Distribution, Population Genetics, and Health Burden of the Hemoglobinopathies. Cold Spring Harbor Perspectives in Medicine. 2012;2(9). doi:10.1101/cshperspect.a011692.
Hassell KL. Population estimates of sickle cell disease in the U.S. Am J Prev Med. 2010;38(4 Suppl):S512–21. doi:10.1016/j.amepre.2009.12.022.
Platt OS, Brambilla DJ, Rosse WF, et al. Mortality in sickle cell disease. Life expectancy and risk factors for early death. N Engl J Med. 1994;330(23):1639–44.
Lanzkron S, Carroll CP, Haywood Jr C. The burden of emergency department use for sickle-cell disease: an analysis of the national emergency department sample database. Am J Hematol. 2010;85(10):797–9. doi:10.1002/ajh.21807.
Brousseau DC, Owens PL, Mosso AL, Panepinto JA, Steiner CA. Acute care utilization and rehospitalizations for sickle cell disease. JAMA. 2010;303(13):1288–94. doi:10.1001/jama.2010.378.
Wolfson JA, Schrager SM, Khanna R, Coates TD, Kipke MD. Sickle cell disease in California: sociodemographic predictors of emergency department utilization. Pediatr Blood Cancer. 2012;58(1):66–73. doi:10.1002/pbc.22979.
Yusuf HR, Atrash HK, Grosse SD, Parker CS, Grant AM. Emergency department visits made by patients with sickle cell disease: a descriptive study, 1999–2007. Am J Prev Med. 2010;38(4 Suppl):S536–41. doi:10.1016/j.amepre.2010.01.001.
Lanzkron S, Haywood Jr C, Segal JB, Dover GJ. Hospitalization rates and costs of care of patients with sickle-cell anemia in the state of Maryland in the era of hydroxyurea. Am J Hematol. 2006;81(12):927–32. doi:10.1002/ajh.20703.
Steiner CA, Miller JL. Sickle cell disease patients in U.S. hospitals, 2004. Rockville, MD: Agency for Health Care Quality; 2006.
Epstein RM, Shields CG, Franks P, Meldrum SC, Feldman M, Kravitz RL. Exploring and validating patient concerns: relation to prescribing for depression. Ann Fam Med. 2007;5(1):21–8.
Wolfson JA, Schrager SM, Coates TD, Kipke MD. Sickle-cell disease in California: a population-based description of emergency department utilization. Pediatr Blood Cancer. 2011;56(3):413–9. doi:10.1002/pbc.22792.
Carroll CP, Haywood C, Fagan P, Lanzkron S. The course and correlates of high hospital utilization in sickle cell disease: evidence from a large, urban Medicaid managed care organization. Am J Hematol. 2009;84(10):666–70. doi:10.1002/ajh.21515.
Herron S, Bacak SJ, King A, DeBaun MR. Inadequate recognition of education resources required for high-risk students with sickle cell disease. Arch Pediatr Adolesc Med. 2003;157(1):104.
King A, Herron S, McKinstry R, et al. A multidisciplinary health care team's efforts to improve educational attainment in children with sickle-cell anemia and cerebral infarcts. J Sch Health. 2006;76(1):33–7. doi:10.1111/j.1746-1561.2006.00064.x.
Smith KE, Patterson CA, Szabo MM, Tarazi RA, Barakat LP. Predictors of academic achievement for school age children with sickle cell disease. Adv Sch Ment Health Promot. 2013;6(1):5–20. doi:10.1080/1754730X.2012.760919.
Jonassaint CR, Beach MC, Lanzkron S, Haywood Jr C. How is patient socioeconomic status related to health care utilization in sickle cell disease? Annual National Sickle Cell Disease Scientific Meeting. 2011.
Arendt JN. In sickness and in health–till education do us part: education effects on hospitalization. Econ Educ Rev. 2008;27(2):161–72.
Woods K, Karrison T, Koshy M, Patel A, Friedmann P, Cassel C. Hospital utilization patterns and costs for adult sickle cell patients in Illinois. Public Health Rep. 1997;112(1):44–51.
Haque A, Telfair J. Socioeconomic distress and health status: the urban–rural dichotomy of services utilization for people with sickle cell disorder in North Carolina. J Rural Health. 2000;16(1):43–55.
Telfair J, Haque A, Etienne M, Tang S, Strasser S. Rural/urban differences in access to and utilization of services among people in Alabama with sickle cell disease. Public Health Rep. 2003;118(1):27–36.
Ellison AM, Bauchner H. Socioeconomic status and length of hospital stay in children with vaso-occlusive crises of sickle cell disease. J Natl Med Assoc. 2007;99(3):192–6.
Aisiku IP, Smith WR, McClish DK, et al. Comparisons of high versus low emergency department utilizers in sickle cell disease. Ann Emerg Med. 2009;53(5):587–93. doi:10.1016/j.annemergmed.2008.07.050.
Smith WR, Penberthy LT, Bovbjerg VE, et al. Daily assessment of pain in adults with sickle cell disease. Ann Intern Med. 2008;148(2):99–101.
Reese FL, Smith WR. Psychosocial determinants of health care utilization in sickle cell disease patients. Ann Behav Med. 1997;19(2):171–8.
Edwards CL, Scales MT, Loughlin C, et al. A brief review of the pathophysiology, associated pain, and psychosocial issues in sickle cell disease. Int J Beh Med. 2005;12(3):171–9. doi:10.1207/s15327558ijbm1203_6.
Start EH, Assistance EL-IPT. The 2011 Health & Human Services (HHS) Poverty Guidelines. Fed Regist. 2011;76(13):3637–8.
Edwards R, Telfair J, Cecil H, Lenoci J. Reliability and validity of a self-efficacy instrument specific to sickle cell disease. Behav Res Ther. 2000;38(9):951–63.
Kohout FJ, Berkman LF, Evans DA, Cornoni-Huntley J. Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. J Aging Health. 1993;5(2):179–93. http://www.ncbi.nlm.nih.gov/pubmed/10125443.
Grant MM, Gil KM, Floyd MY, Abrams M. Depression and functioning in relation to health care use in sickle cell disease. Ann Behav Med. 2000;22(2):149–57.
Edwards R, Telfair J, Cecil H, Lenoci J. Self-efficacy as a predictor of adult adjustment to sickle cell disease: one-year outcomes. Psychosom Med. 2001;63(5):850–8.
Maxwell K, Streetly A, Bevan D. Experiences of hospital care and treatment seeking for pain from sickle cell disease: qualitative study. BMJ. 1999;318(7198):1585–90.
Schwartz LA, Radcliffe J, Barakat LP. Associates of school absenteeism in adolescents with sickle cell disease. Pediatr Blood Cancer. 2009;52(1):92–6. doi:10.1002/pbc.21819.
Wang W, Enos L, Gallagher D, et al. Neuropsychologic performance in school-aged children with sickle cell disease: a report from the Cooperative Study of Sickle Cell Disease. J Pediatr. 2001;139(3):391–7. doi:10.1067/mpd.2001.116935.
Day S, Chismark E. The cognitive and academic impact of sickle cell disease. J Sch Nurs. 2006;22(6):330–5.
Farber MD, Koshy M, Kinney TR. Cooperative study of sickle cell disease: demographic and socioeconomic characteristics of patients and families with sickle cell disease. J Chronic Dis. 1985;38(6):495–505.
Taras H, Potts-Datema W. Chronic health conditions and student performance at school. J Sch Health. 2005;75(7):255–66. doi:10.1111/j.1746-1561.2005.00034.x.
van Heesch MM, Bosma H, Traag T, Otten F. Hospital admissions and school dropout: a retrospective cohort study of the 'selection hypothesis'. Eur J Public Health. 2012;22(4):550–5. doi:10.1093/eurpub/ckr129.
Chua-Lim C, Moore RB, McCleary G, Shah A, Mankad VN. Deficiencies in school readiness skills of children with sickle cell anemia: a preliminary report. South Med J. 1993;86(4):397–402.
Schatz J, Brown RT, Pascual JM, Hsu L, DeBaun MR. Poor school and cognitive functioning with silent cerebral infarcts and sickle cell disease. Neurology. 2001;56(8):1109–11.
Vichinsky EP, Neumayr LD, Gold JI, et al. Neuropsychological dysfunction and neuroimaging abnormalities in neurologically intact adults with sickle cell anemia. JAMA. 2010;303(18):1823–31. doi:10.1001/jama.2010.562.
Mayes S, Wolfe-Christensen C, Mullins LL, Cain JP. Psychoeducational screening in pediatric sickle cell disease: an evaluation of academic and health concerns in the school environment. Child Health Care. 2011;40(2):101–15. doi:10.1080/02739615.2011.566465.
Dyson SM, Atkin K, Culley LA, Dyson SE, Evans H, Rowley DT. Disclosure and sickle cell disorder: a mixed methods study of the young person with sickle cell at school. Soc Sci Med. 2010;70(12):2036–44. doi:10.1016/j.socscimed.2010.03.010.
Dyson SM, Atkin K, Culley LA, Dyson SE. The educational experiences of young people with sickle cell disorder: a commentary on the existing literature. Disabil Soc. 2007;22(6):581–94. doi:10.1080/09687590701560196.
Koontz K, Short AD, Kalinyak K, Noll RB. A randomized, controlled pilot trial of a school intervention for children with sickle cell anemia. J Pediatr Psychol. 2004;29(1):7–17.
Dyson SM, Atkin K, Culley LA, Dyson SE, Evans H. Sickle cell, habitual dys-positions and fragile dispositions: young people with sickle cell at school. Sociol Health Illn. 2011;33(3):465–83. doi:10.1111/j.1467-9566.2010.01301.x.
Muennig P, Schweinhart L, Montie J, Neidell M. Effects of a prekindergarten educational intervention on adult health: 37-year follow-up results of a randomized controlled trial. Am J Public Health. 2009;99(8):1431–7. doi:10.2105/AJPH.2008.148353.
Acknowledgements
The primary author would like to thank Andrea Ball for her indispensible intellectual contributions and editing assistance in the preparation of this manuscript.
Study data were collected and managed using REDCap electronic data capture tools hosted at The Johns Hopkins University. REDCap (Research Electronic Data Capture) is a secure, Web-based application designed to support data capture for research studies, providing (1) an intuitive interface for validated data entry; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; and (4) procedures for importing data from external sources.
Funding
This study was funded by NHLBI grant no. 5R01HL088511-04
Dr. Haywood is funded by a career development award from the NHLBI: 5 K01 HL108832 02.
Dr. Jonassaint was supported by grant number K12HS022989 from the Agency for Healthcare Research and Quality.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the NHLBI or the Agency for Healthcare Research and Quality.
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The authors declare that they have no competing interests.
Ethical Approval
This study was approved by the Howard University and the Johns Hopkins Hospital Institutional Review Boards.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Jonassaint, C.R., Beach, M.C., Haythornthwaite, J.A. et al. The Association between Educational Attainment and Patterns of Emergency Department Utilization among Adults with Sickle Cell Disease. Int.J. Behav. Med. 23, 300–309 (2016). https://doi.org/10.1007/s12529-016-9538-y
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DOI: https://doi.org/10.1007/s12529-016-9538-y