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Neighborhood Deprivation and Racial Cohesion are Associated with Reduced Acute Chest Syndrome Recurrence in Sickle Cell Disease Children
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  • Ammar Alishlash,
  • Sarah Rutland,
  • Annabelle Friedman,
  • Jane Hampton,
  • Anis Nourani,
  • Jeffrey Lebensburger,
  • Gabriela Oates
Ammar Alishlash
The University of Alabama at Birmingham
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Sarah Rutland
The University of Alabama at Birmingham
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Annabelle Friedman
The University of Alabama at Birmingham
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Jane Hampton
The University of Alabama at Birmingham
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Anis Nourani
The University of Alabama at Birmingham
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Jeffrey Lebensburger
University of Alabama-Birmingham
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Gabriela Oates
The University of Alabama at Birmingham
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Abstract

Background: Acute chest syndrome (ACS) is the leading cause of death for children with sickle cell disease (SCD). Recurrent ACS has detrimental effects on pulmonary health and healthcare costs. Neighborhood characteristics affect the outcomes of many pediatric chronic diseases, but their role in SCD is not well investigated. In this study, we investigated the effects of area-level socioeconomic deprivation and racial composition on the recurrence of ACS. Study design: We performed a retrospective cross-sectional analysis of clinical data from a large pediatric SCD center. Patients’ residential addresses were geocoded and linked to a composite Area Deprivation Index (ADI) and percent African American population at the level of Census block groups. The association of recurrent ACS with neighborhood characteristics was evaluated using logistic regression analysis. Results: The sample included 709 children with SCD. Residence in a socioeconomically deprived neighborhood was associated with 27% less risk of recurrent ACS, and residence in a predominantly African American neighborhood was associated with 41% less risk of ACS recurrence. The racial composition explained the protective effect of living in a high-deprivation area after adjusting for sociodemographic and clinical covariates. Demographic and clinical factors associated with recurrent ACS included older age, male gender, asthma, hydroxyurea use, and chronic transfusion therapy. Conclusions: This is the first study to report a protective effect of residing in a predominantly African American community for ACS recurrence. Further prospective studies are needed to confirm the association and to understand the mechanisms of such relationship.

Peer review status:ACCEPTED

02 Oct 2020Submission Checks Completed
02 Oct 2020Assigned to Editor
02 Oct 2020Submitted to Pediatric Blood & Cancer
03 Oct 2020Reviewer(s) Assigned
26 Oct 2020Review(s) Completed, Editorial Evaluation Pending
26 Oct 2020Editorial Decision: Revise Major
16 Nov 2020Assigned to Editor
16 Nov 2020Submission Checks Completed
16 Nov 20201st Revision Received
17 Nov 2020Reviewer(s) Assigned
29 Nov 2020Review(s) Completed, Editorial Evaluation Pending
30 Nov 2020Editorial Decision: Revise Minor
10 Dec 2020Submission Checks Completed
10 Dec 2020Assigned to Editor
10 Dec 20202nd Revision Received
12 Dec 2020Review(s) Completed, Editorial Evaluation Pending
12 Dec 2020Editorial Decision: Accept