Abstract T P327: The Association of Neighborhood and Transcranial Doppler Screening Among Children with Sickle Cell Disease
Background: Although Transcranial Doppler (TCD) screening is recommended to assess the need for stroke prevention efforts among children with sickle cell disease (SCD), screening rates are low. Few individual level factors that impact screening have been identified, and little is known regarding the degree to which neighborhoods may influence screening. We sought to identify neighborhoods with low TCD screening rates and neighborhood-level factors related to screening among children with SCD to inform the utility of community level interventions to improve TCD screening.
Methods: Children ages 2-16 years with SCD (HbSS, HbBeta-Thalessemia) were identified in Michigan Medicaid (2007-2011) through newborn screening records and were continuously enrolled for ≥1 year; each child could contribute multiple years. We determined receipt of ≥1TCD screening (y/n) each year from claims. Neighborhood of residence was defined by census tract on January 1 of each year and proportion of children receiving TCD in the tract was calculated. Tracts were investigated for clustered areas of screening globally (Moran’s I) as well as for local areas (Gi* statistic). Median household income, % unemployment, and % black residents for each tract were ascertained from the American Community Survey. Logistic regression with generalized estimating equations was used to model the association between TCD screening and each neighborhood-level factor, adjusted for age.
Results: In 2007, there were 218 children with SCD in Michigan Medicaid (50% female, 98% black, 87% HbSS) with a total of 1,008 person-years eligible for analysis in 293 census tracts. Median and mean screening rate in tracts were 0% and 21%. Screening rates were spatially random in the study area (p=0.60). No tracts were identified with locally lower screening rates than the mean, but 27 tracts showed locally higher screening rates (Gi*>1.96). No neighborhood factors were associated with receipt of screening when adjusted for age.
Conclusion: Neighborhood factors were not found to be associated with receipt of TCD, although some neighborhoods showed higher than average screening rates. Further investigation of the characteristics of these neighborhoods may suggest ways to improve screening in surrounding areas.
Author Disclosures: S.L. Reeves: Research Grant; Significant; American Heart Association Predoctoral Fellowship. K.J. Dombkowski: None. H. Fullerton: Research Grant; Significant; NIH and AHA. T. Braun: None. L.D. Lisabeth: None.
This research has received full or partial funding support from the American Heart Association, Midwest Affiliate – Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota, Wisconsin.
- © 2014 by American Heart Association, Inc.