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Health Disparities
Everardo Cobos, MD
Hematology Division
Summer Seminar on Health Disparities
Sickle Cell Anemia & Health
Disparities: outline
Review of sickle cell anemia
Brief review of health disparities
Interplay between sickle cell anemia and
health disparity
Increase awareness of racial, ethnic, gender,
geographic disparities in health care among
the general public and key stakeholders, and
increase health care providers awareness of
disparities
What is Sickle Cell Anemia (SCA)?
First described in Chicago in 1910 by James Herrick
as an inherited condition that results in a decrease in
the ability of red blood cells to carry oxygen
throughout the body
HbS
Recessive
S=Sickle
A=Normal
Genetic disease NOT a black
disease
Some Genetic History
The error in the hemoglobin gene results from a genetic
mutation that occurred many thousands of years ago in people
in parts of Africa, the Mediterranean basin, the Middle
East, and India.
Infectious complications
Prominent early in life
Leading cause of morbidity and mortality
Great improvement in the prognosis related to newborn
screening for sickle cell disease, vaccination for childhood
illnesses, the use of prophylactic antibiotics, and aggressive
diagnosis and treatment of febrile events
Acute splenic sequestration
Episodes of rapid increase in splenic size and decrease in
hemoglobin
Potential source of morbidity and mortality early in life for
children with sickle cell anemia and at any age for those with Hb
SC disease and sickle thalassemia
Serious Complications
Strokes
Up to 15% of children may have overt or silent strokes during
childhood
Chronic transfusion therapy reduces the recurrence rate of
overt stroke which may approach 75% without intervention
Bone disease
Early risk is primarily from osteomyelitis
Infectious usually painful inflammatory disease of bone often of
bacterial origin and may result in bone tissue death
Avascular necrosis of the femur and humerus
Death of bone tissue due to disrupted blood supply
Marked by severe pain in the affected region and by
weakened bone that may flatten and collapse
Serious Complications
Leg ulcers
Seen in patients older than 10 years of age
Resistant to therapy and cause significant morbidity
Ophthalmic complications
Proliferative retinopathy, vitreous hemorrhage, & retinal detachment
Priapism
Distressing complication that occurs at all ages
Difficult to treat
Causes a high incidence of impotence
Chronic Anemia
Associated with fatigue, irritability, jaundice, pain, delayed puberty, leg
sores, eye problems, gum disease
Serious Complications: PAIN
Recurrent Pain Episodes or Sickling Crises
Assess the extent of racial and ethnic differences in healthcare that are
not otherwise attributable to known factors such as access to care (e.g.,
ability to pay or insurance coverage);
Black-to-
Black White
White Ratio
Angioplasty
2.5 5.4 0.46
(procedures per 1,000 beneficiaries per year)
Coronary Artery Bypass Graft Surgery
1.9 4.8 0.40
(procedures per 1,000 beneficiaries per year)
Mammography
17.1 26.0 0.66
(procedures per 100 women per year)
Hip Fracture Repair
2.9 7.0 0.42
(procedures per 100 women per year)
Amputation of All or Part of Limb
6.7 1.9 3.64
(procedures per 1,000 beneficiaries per year)
Bilateral Orchiectomy
2.0 0.8 2.45
(procedures per 1,000 beneficiaries per year)
Source: Gornick et al., 1996
Differences, Disparities, and Discrimination: Populations with
Equal Access to Health Care
Clinical Appropriateness
and Need
Patient Preferences
Difference
The Operation of Healthcare
Non-Minority
Disparity
Discrimination: Biases and
Minority
GENERAL RECOMMENDATIONS
Source: http://www.nbcchicago.com/brchannel/FP-HLX-Background-
Information-on-Sickle-Cell-Disease.html#ixzz0uHEhUidB
Marker of Negative Attitudes and Their Manifestations in
the Delivery of Care to Patients with Sickle Cell
Disease
Marker Manifestation
Segregation Establishment of nonteaching service managed by a nurse
practitioner or physician assistant.
JAMA. 2009;302(22):2479-2480.
I do not believe what you say. Finally, I received pain meds with some relief.
There will be no prescription today. This greatly reduced my grief.
You did not keep the terms of our agreement They decided to admit me to the hospital
And, hence, there will be no treatment. A decision that was most acceptable.
I dragged myself to the emergency room. I was happy to come to the end of my ordeal
There I was also met with doubt and gloom. And to be treated with respect and more zeal.