Comparing Social Determinants of Health Across Early and Late Phases of the COVID-19 Pandemic in Pediatric Sickle Cell Disease.

Background

COVID-19 had a disproportionate impact on the health of individuals with sickle cell disease (SCD). While numerous studies have documented that patients with SCD were at increased risk for morbidity and mortality, limited research has examined its effects on social determinants of health (SDOH) among families of children with SCD. PROCEDURE The study was divided into two phases: early pandemic and late pandemic. Caregivers completed surveys about food insecurity, housing, and employment status.

Results

Fifty-nine caregivers were surveyed during the early pandemic period; 61 were surveyed during the late pandemic period. Caregivers were significantly more likely to report food insecurity in the late pandemic period as compared to the early pandemic period (OR = 4.47; 95% CI = 1.20, 20.46). Those with lower monthly income ($1000-1999) were more likely to report food insecurity, as compared to caregivers within the monthly income range of $4000 or more. Caregivers who were born outside the United States and who had lower income were significantly more likely to report food insecurity as compared to caregivers who were born in the United States or had an income within the range of $4000. No significant differences were noted between the two periods in terms of housing, employment, or financial insecurity.

Conclusions

We found significant associations between demographic characteristics and SDOH. While some aspects of food insecurity worsened during the late pandemic, others improved. We did not observe significant changes in housing or employment insecurity across pandemic periods, potentially suggesting either resilience or sustained hardship.