349 - Contribution of neighborhood safety to the frequency of emergency department visits for emerging adults with sickle cell disease

Poster Number: 349
Publication Number: 349.1962

Background: Emerging adults with sickle cell disease (SCD) have the highest rate of emergency department (ED) visits relative to other age groups. Neighborhood safety has been studied as a potential contributor to worse quality of life and disease outcomes, including ED utilization. These studies, however, often did not look at ED visits specifically as a dependent variable and/or had limited geographic scope.

Objective: In this study, we analyze the contribution of neighborhood safety to the frequency of ED visits for SCD patients.

Design/Methods: We analyzed baseline surveys of the COMETS study, a randomized controlled trial of a cohort of patients with SCD across 5 hospital sites who are >=17-years-old and transitioning to an adult provider within 12 months. Primary outcome of this analysis was self-reported ED visits in the last 6 months. Primary predictor was neighborhood safety from the COVID Impact Survey. Covariates included demographics, parental status, household composition, employment status, education level, insurance type, disease severity. Bivariate and logistic regression were used to determine predictors of ED utilization.

Results: A total of 246 patients (52.1% female sex, 91.4% Black, 92.2% not Hispanic/Latino) reported feeling safe in their neighborhood, and 10 patients (70% female sex, 100% Black, 100% not Hispanic/Latino) reported not feeling safe. Of those who reported feeling safe, 47.3% had 0-1 ED visits and 34.4% had 2+ ED visits. Of those who reported not feeling safe, 30% had 0-1 ED visits and 60% had 2+ ED visits. A bivariate analysis shows a positive correlation and between neighborhood safety and ED visits (beta = 0.945, p = 0.17). The overall model for testing the odds of ED utilization was significant; however, neighborhood safety was not a statistically significant predictor. Disease severity and sex were significant predictors with the odds of 2+ ED utilization increasing by 2.329 times for females and 2.954 times for severe disease.

Conclusion(s): Although positively correlated, neighborhood safety was not shown to be a significant predictor of frequency of ED visits, though the study was limited by the small sample of participants who felt unsafe in their neighborhoods.