Association of Socioeconomic and Age Group Status with Self-reported Health Outcomes of Persons with SCD in Rural and Urban Areas of North Carolina

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Association of Socioeconomic and Age Group Status
with Self-reported Health Outcomes of Persons
with SCD in Rural and Urban Areas of North
Carolina
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AUTHORS/REFERENCE

• Aklaque Haque, PhD, Dept of Government and Public
  Services - Sch. Of Social and Behavioral
  Sciences, University of Alabama at Birmingham
• Joseph Telfair, DrPH, MSW/MPH, Sch. Of Public
  Health, University of Alabama at Birmingham
• Reference Haque, A Telfair, J (in press).
  Socioeconomic distress and Health Status The
  Urban-Rural dichotomy of services utilization for
  persons with SCD in NC. J. Rural Health

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Thank You

• Individuals with SCD and their families
• Members of the Duke/UNC CSCC
• Staff of the Four NC SC Community-based programs
• Duke/UNC CSCC Biometry Core
• David Redden CCC Biostatistical Core, UAB

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BACKGROUND

• Research addressing risk factors associated with
  SCD - predominantly biomedical bioclinical
• This research has led to reduced morbidity,
  better treatment outcomes raised awareness of
  the need for comprehensive biomedical and
  psychosocial treatment strategies
• This research has failed to consider impact of
  the interaction of socioeconomic background and
  geographic distribution has had on health care
  delivery and medical outcomes

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BACKGROUND SCD IN NC

• NC SCD Consortium provides much of the outreach,
  education, social, health and medical care
• NC SCD Consortium
• 3 state level administrative and 9 (regional)
  level Educator/Counselor
• 5 major tertiary medical centers (only 2 serve
  adults) for comprehensive care
• 4 community-based centers
• Consortium survey suggested differential access

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PURPOSE OF THE STUDY

• To gain an understanding of how access
  utilization of services may be affected
  separately and interactively by age,
  socioeconomic conditions, geographic location,
  functional status, severity of disease distance
  to medical care
• To introduce Social Epidemiological Methods to
  the study of issues impacting persons with SCD

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METHODS PARTICIPANTS

• 1189 of 1298 adults and children with SCD at
  intake (1991-1995)
• Served by the three medical centers in the
  Duke/UNC CSCC (68) of estimated SCD population
  in NC, consent obtained
• Intake Qs information
• self-reported demographic, medical history,
  psychological and social data
• objective physical exam, laboratory and medical
  records

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METHODS MEASURES

• Community Distress Index(CDI)
• Based on Haques Econometric Model
• 5 indicators of poor QOL based on 1990 U.S.
  Census Indicators
• income (Black per capita income)
• education ( Black not beyond HS)
• poverty ( Black below poverty)
• unemployment ( Black unemployed)
• not in labor force ( Black not in labor force)
• Index Score(SUM) - Low, Medium, High distress

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METHODS MEASURES

• SCD Interference Index (SCDII) - Child/Adult
• Based on Psychosocial Interference Scale (Kramer
  Nash, 1992)
• 8 items for each (e.g., School/ Employment
  attendance, school/employment performance,
  household activities, etc.)
• Coding
• Interference - YES (1) NO (0)
• Amount of Interference - Rare (1) Somewhat (2) A
  lot (3)
• Index Score(SUM) - None, Low, Medium, High

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METHODS MEASURES

• Medical Problem Index (MPI)
• Index items based on anecdotal, clinical and
  evidence-based research information
• Event groupings (most common)-
• Problem (Acute Chest/Pneumo, Pain req Hosp)
• Condition (Ascep Nec Hips Shoulders,
  Gallstones, eye problems)
• Infection (osteomyelitis, pyelonephritis)
• Procedure (cholecystectomy splenectomy)
• Index score(SUM) - none, low, medium, high

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Results Ia
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Results Ib
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Results Ic
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Results II
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CONCLUSIONS

• This study has allowed for the the investigation
  of the observation that a wide disparity has been
  observed in socioeconomic characteristics among
  urban and rural persons with SCD in NC
• When controlling for age and location, the
  significant relationships between indices
  persist.
• Specifically, rural clients of all ages live
  under relatively more distressed economic
  conditions than urban clients and younger clients
  are wore-off than older clients, yet for
  youngsters CDI is not a contributing factor to
  higher interference

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CONCLUSIONS

• Supports contention, youngsters with SCD, in NC
  have, in general, have better familial and
  systems level supports that may buffer physical
  and social consequences
• For adults the supports are limited and
  inadequate to compensate for hardships,
  especially in rural areas
• By changing the policy to create a more equitable
  of system of supports rural and age differentials
  can be effectively addressed
• These findings have particular implications for
  states with a 40 or greater rural population

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Limitations of the Study

• The study uses zip code linked SES data as the
  basis for determining CDI score areas, a very
  good proxy measure, but may fully reflect the
  individual level SES of the client
• Interference for children (not adolescents) is
  generally reported by parents and guardians, a
  good approach, but is limited by the parents
  perception
• Current research is underway in Alabama aimed at
  addressing these limitations and improving on
  this study