Impact of Socioeconomic & Age Group on Health of Rural vs Urban SCD Patients in NC

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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

10. METHODS: MEASURES Community Distress Index(CDI) • Based on Haque’s 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

11. 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

12. 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

13. Results Ia

14. Results Ib

15. Results Ic

16. Results II

17. 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

18. 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

19. 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 parent’s perception • Current research is underway in Alabama aimed at addressing these limitations and improving on this study