ObjectivesWe used the National Health Interview Survey (NHIS) data set to examine the prevalence of comorbid medical conditions; explore barriers to accessing healthcare and special educational services; and assess the associations between sickle cell disease (SCD) status and demographics/socioeconomic status (SES), and social determinants of health (SDoH) on comorbidities among children in the USA.DesignCross-sectional.SettingNHIS Sample Child Core questionnaire 2007–2018 data set.Participants133 481 children; presence of SCD was determined by an affirmative response from the adult or guardian of the child.Main outcome measuresMultivariate logistic regression was used to compare the associations between SCD status, SES and SDoH for various medical conditions for all races and separately for black children at p<0.05.Results133 481 children (mean age 8.5 years, SD: 0.02), 215 had SCD and ~82% (weighted) of the children with SCD are black. Children with SCD were more likely to suffer from comorbid conditions, that is, anaemia (adjusted OR: 27.1, p<0.001). Furthermore, children with SCD had at least two or more emergency room (ER) visits (p<0.001) and were more likely to have seen a doctor 1–15 times per year (p<0.05) compared with children without SCD. Household income (p<0.001) and maternal education were lower for children with SCD compared with children without SCD (52.4% vs 63.5% (p<0.05)). SCD children with a maternal parent who has < / > High School degree were less likely to have no ER visits or 4–5 ER visits, and more likely to have 2–3 ER visits within 12 months.ConclusionChildren with SCD experienced significant comorbid conditions and have high healthcare usage, with black children being disproportionately affected. Moreover, maternal education status and poverty level illustrates how impactful SES can be on healthcare seeking behaviour for the SCD population. SDoH have significant implications for managing paediatric patients with SCD in clinical settings.

The double burden of HIV/AIDS and tuberculosis (TB), coupled with endemic and problematic food insecurity in Africa, can interact to negatively impact health outcomes, creating a syndemic. For people living with HIV/AIDS (PWH), food insecurity is a significant risk factor for acquiring TB due to the strong nutritional influences and co-occurring contextual barriers. We aim to synthesize evidence on the syndemic relationship between HIV/AIDS and TB co-infection and food insecurity in Africa. We conducted a scoping review of studies in Africa that included co-infected adults and children, with evidence of food insecurity, characterized by insufficient to lack of access to macronutrients. We sourced information from major public health databases. Qualitative, narrative analysis was used to synthesize the data. Of 1072 articles screened, 18 articles discussed the syndemic effect of HIV/AIDS and TB co-infection and food insecurity. Reporting of food insecurity was inconsistent, however, five studies estimated it using a validated scale. Food insecure co-infected adults had an average BMI of 16.5–18.5 kg/m2. Negative outcomes include death (n = 6 studies), depression (n = 1 study), treatment non-adherence, weight loss, wasting, opportunistic infections, TB-related lung diseases, lethargy. Food insecurity was a precursor to co-infection, especially with the onset/increased incidence of TB in PWH. Economic, social, and facility-level factors influenced the negative impact of food insecurity on the health of co-infected individuals. Nutritional support, economic relief, and psychosocial support minimized the harmful effects of food insecurity in HIV–TB populations. Interventions that tackle one or more components of a syndemic interaction can have beneficial effects on health outcomes and experiences of PWH with TB in Africa.

Background: In the United States , sickle cell disease (SCD), affects about 100,000 individuals, with roughly 2,000 babies born annually with SCD. African Americans are disproportionately affected by SCD. In addition to medical conditions, psychosocial and affective comorbidities are also observed in relation to the frequency and intensity of pain crises. Evidence also suggests robust academic challenges that begin in elementary school and persist until high school. It is estimated that about 25% to 33% of children with SCD experience neurodevelopmental complications. Neurological complications lead to cognitive deficits and educational challenges. African Americans and those with low socioeconomic status are affected the most by neurological complications. Among Children with SCD, data suggest that specialized school service utilization rates are about 37%, and grade retention ranges from 28% to 40%. We used the 2007-2018 NHIS to describe additional neurocognitive impairments and health services used among Black children aged 0-17 years with SCD and place findings into context. Methods: Data was acquired from the NHIS database. The study included an unweighted sample of 133,542 children, with 68,745 male children and 64,797 female children. Questionnaires were answered by a parent/guardian on behalf of the child. We examined (1) the prevalence of neurological conditions; (2) indicators of functional status and perceived health status; (3) use of healthcare and special educational services; (4) barriers to accessing healthcare services for a national sample of children with SCD; (5) Association of the comorbidities with the utilization of care. We hypothesized that black children with SCD would have higher levels of disease-related complications and comorbidities, as well as healthcare utilization than their counterparts without SCD. We used logistic regression to compare the associations between SCD and No SCD on various neurological conditions for all races and for Black children only groups. Results: Of the 133,542 children, 215 have SCD (.16%). Among the SCD children, 51.1% are male, 170 (79.1%) are Black, 16 (7.44%) are White, 1(.47%) are American Indian, 2 (.93%) are Asian, 21 (9.77%) are other races, and 5 (2.33%) are of Multiple Races. Among all races, Black children had a higher prevalence of SCD than other races. Black children with SCD had a higher predominance of girls than did those without SCD. They were also more likely than their counterparts without SCD to have a household income &lt; 1% of the federal poverty levels. After applying the appropriate weights to each of the demographics, Children with SCD had higher odds of having a developmental condition such as: learning disability (Adjusted odds ratio -AOR 1.5; CI: .7, 3.5: p=0.311), intellectual disability (AOR 4.2; CI: 1.3, 13.3: p=0.014), trouble hearing (AOR 2.6; CI: 1.1, 6.1: p=0.026), trouble seeing (AOR 2.3; CI: 1.0, 5.3: p=0.061) and another developmental delay (AOR .8; CI: .1, 6.2: p=0.838). We see similar results in the Black children only sample where Black children with SCD were more likely to have a learning disability (AOR 1.3; CI: .5, 3.2; p=0.590), intellectual disability (AOR 2.4; CI: .6, 10.2: p=0.236), trouble hearing (AOR 1.6; CI: .6, 4.1: p=0.310) or trouble seeing (AOR 2.3; CI: 1.0, 5.4; p=0.048). They also exhibit other developmental delays (AOR 1.9; CI: .2, 22.4: p=0.625), although not statistically significant. Conclusion: In this study sample, it is clear that children with SCD had higher odds of having a developmental condition and in addition Black children with SCD also have a comparable odd of developing neurological complications compared to children with SCD of other races. A similar pattern was identified that Black children with SCD reported increased utilization of healthcare and special education services in the past 12 months. This creates the urgency to address the health burden for Black children with SCD that has been exaggerated by barriers to accessing comprehensive health care. Studies that further assess Black children's health burden with SCD, its neurocognitive impairment and healthcare utilization is crucial. Disclosures No relevant conflicts of interest to declare.

This study compared neurological complications among a national sample of United States children with or without sickle cell disease (SCD) and evaluated health status, healthcare and special education utilization patterns, barriers to care, and association of SCD status and demographics/socioeconomic status (SES) on comorbidities and healthcare utilization. Data was acquired from the National Health Interview Survey (NHIS) Sample Child Core questionnaire 2007–2018 dataset that included 133,542 children. An affirmation from the guardian of the child determined the presence of SCD. Regression analysis was used to compare the associations between SCD and demographics/SES on neurological conditions at p < 0.05. Furthermore, adjusted odds ratios (AORs) were estimated for having various neurological conditions. Of the 133,481 children included in the NHIS, the mean age was 8.5 years (SD: 0.02) and 215 had SCD. Of the children with SCD, the sample composition included male (n = 110), and Black (n = 82%). The SCD sample had higher odds of having neuro-developmental conditions (p < 0.1). Families of Black children (55% weighted) reported household incomes < 100% of federal poverty level. Black children were more likely to experience longer wait times to see the doctor (AOR, 0.3; CI 0.1–1.1). Compared to children without SCD, those with SCD had a greater chance of seeing a medical specialist within 12 months (AOR 2.3; CI 1.5–3.7). This representative sample of US children with SCD shows higher odds of developing neurological complications, increased healthcare and special education services utilization, with Black children experiencing a disproportionate burden. This creates the urgency to address the health burden for children with SCD by implementing interventions in healthcare and increasing education assistance programs to combat neurocognitive impairments, especially among Black children.

Background: Sickle cell disease (SCD), one of the most common genetic disorders in the United States (US), affects 70,000 to 100,000 children. The burden is greatest among the African American population, where SCD impacts 1 in 365 live births. Children with SCD have been observed to have lower Health-Related Quality of life (HRQoL) due to the impact of severe disease-related complications and comorbidities, including infections, pain crises, acute chest syndrome, metabolic alterations and overt stroke. SCD and its related comorbidity and complications result in increased health care utilization, particularly emergency department use- which accounts for 80% of medical expenditure. Further, studies using US population-based data to characterize the health status and health care utilization for SCD children is lacking. With the exception of a study conducted by Boulet et al. in 2010, which examined the 1997-2005 National Health Interview Surveys (NHIS) data to describe health status and health services use among Black children aged 0-17 years with SCD. To fill this important gap, we used the 2007-2018 NHIS data to describe health status and health services use among SCD children aged 0-17 years and conducted a sub-analysis for Black children to better characterize SCD- related medical conditions affecting this population and health care utilization patterns. Methods: The study included an unweighted sample of 133,542 children, with 68,745 male children and 64,797 female children. Questionnaires were answered by a parent/guardian on behalf of the child. We examined (1) the prevalence of medical comorbidities; (2) indicators of functional status and perceived health status; (3) use of healthcare services; (4) barriers to accessing healthcare services; and (5) association of the comorbidities with the utilization of care. We hypothesized that Black children with SCD would have higher levels of disease-related complications and comorbidities, as well as healthcare utilization than their counterparts without SCD. We used logistic regression to compare the associations between 'SCD' and 'No SCD' on various medical conditions for all races and for Black children only groups. Results: Of the 133,542 children, 215 have SCD (.16%). Among the SCD children, 51.1% are male, Black: 170 (79.1%), White: 16 (7.44%), American Indian: 1(.47%), Asian 2 (.93%): other races: 21 (9.77%) and Multiple Races 5 (2.33%). Black children had a higher prevalence of SCD than other races and Black children with SCD were more likely to have a household income &lt; 1% of the federal poverty levels compared to those without. After applying the appropriate weights to each of the demographics, children of all races with SCD had higher adjusted odds (Adjusted Odds Ratio -AOR) of having anemia (AOR 37.6; CI: 22.3, 63.3: p=0.000), respiratory allergies (AOR 2.2; CI: 1.3, 3.8; p=0.005), food/digestive allergies (AOR 2.1; CI: 1.0, 4.1: p=0.042), eczema/skin allergies (AOR 2.1; CI: 1.3, 3.6: p=0.004), and frequent severe headaches/migraines (AOR 2.2; CI: 1.1, 4.3; p=0.024). Children with SCD are also more likely to experience frequent diarrhea/colitis, although statistically non-significant. Among Black children, those with SCD had higher odds of having the following medical conditions including anemia (AOR 18.7; CI: 10.7,32.3: p=0.000), and respiratory allergies (AOR 2.4; CI: 1.3, 4.4: p=0.004) and also more likely to experience other conditions including food/digestive allergies, eczema/skin allergies, and frequent severe headaches/migraines, although statistically non-significant (p&gt;0.5). Children of all races (26.0%) and Black children (28.8%) with SCD had at least 2 or more annual emergency room visits (p=0.000). Conclusion: Our study findings indicate that children with SCD for all races experienced significant comorbid conditions associated with disease status. Moreover, among Black children, those with SCD have increased SCD related comorbidity, worse health status, and an increased number of visits to the emergency room compared to children without SCD. This creates the urgency to address the health burden for Black children with SCD, by identifying 'beneficial' health care utilization services (non-emergency services) that improves the quality of life for SCD children. Future research should address residual gaps in information about health burden and healthcare utilization among SCD population in the US. Disclosures No relevant conflicts of interest to declare.