Social and behavioral factors in sickle cell disease: Employment predicts decreased health care utilization

The purpose: to determine frequency of health care encounters among people with sickle cell disease (SCD) seeking treatment for a vaso- occlusive crisis (VOC). Health care encounters are categorized by visit type (day hospital, ED visit, hospitalization), prevalence of self- reported behavioral and social factors, and any associations between behavioral and social factors and health care encounters. Ninety- five people with SCD were enrolled in a prospective descriptive study in North Carolina. Patients were interviewed concerning behavioral- social factors, and a report of health care encounters was produced, generated by ICD codes associated with VOCs between October 2011 and March 2014. Among 95 patients, there were a total of 839 day hospital and 1,990 ED visits, and 1,101 hospital admissions. Prevalent behavioral and social factors were depression (29%), anxiety (34%), illicit drug use (6%); unstable home situation (17%); and unemployment (81%). Employment and stable home were significantly associated with decreased frequency of health care encounters.