{"id":"https://openalex.org/W7135347702","doi":null,"title":"The Impact of Neighborhood Inequities on Engagement in Care among Adolescents and Young Adults with Sickle Cell Disease","display_name":"The Impact of Neighborhood Inequities on Engagement in Care among Adolescents and Young Adults with Sickle Cell Disease","publication_year":2025,"publication_date":"2025-09-15","ids":{"openalex":"https://openalex.org/W7135347702"},"language":"en","primary_location":{"id":"pmh:oai:repository.upenn.edu:20.500.14332/62076","doi":null,"is_oa":true,"landing_page_url":"https://repository.upenn.edu/handle/20.500.14332/62076","pdf_url":null,"source":{"id":"https://openalex.org/S4306402083","display_name":"ScholarlyCommons (University of Pennsylvania)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I79576946","host_organization_name":"University of Pennsylvania","host_organization_lineage":["https://openalex.org/I79576946"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"Presentation"},"volume":null,"type":"other","indexed_in":[],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://repository.upenn.edu/handle/20.500.14332/62076","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5159863689","display_name":"Sana Bakir","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Bakir, Sana","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"last","author":{"id":"https://openalex.org/A5003595830","display_name":"Kemar V. Prussien","orcid":"https://orcid.org/0000-0001-5012-9425","observed_orcids":["https://orcid.org/0000-0001-5012-9425"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Prussien, Kemar V.","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":0,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10554","display_name":"Hemoglobinopathies and Related Disorders","score":0.9413999915122986,"subfield":{"id":"https://openalex.org/subfields/2716","display_name":"Genetics"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10554","display_name":"Hemoglobinopathies and Related Disorders","score":0.9413999915122986,"subfield":{"id":"https://openalex.org/subfields/2716","display_name":"Genetics"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10235","display_name":"Health disparities and outcomes","score":0.027499999850988388,"subfield":{"id":"https://openalex.org/subfields/3306","display_name":"Health"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T12823","display_name":"Adolescent and Pediatric Healthcare","score":0.008799999952316284,"subfield":{"id":"https://openalex.org/subfields/3616","display_name":"Speech and Hearing"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/sickle-cell-disease","display_name":"sickle cell disease","score":1.0},{"id":"https://openalex.org/keywords/adolescents-and-young-adults","display_name":"adolescents and young adults","score":0.9959999918937683},{"id":"https://openalex.org/keywords/structural-racism","display_name":"structural racism","score":0.8330000042915344},{"id":"https://openalex.org/keywords/neighborhood-poverty","display_name":"neighborhood poverty","score":0.7129999995231628},{"id":"https://openalex.org/keywords/household-income","display_name":"household income","score":0.7900000214576721},{"id":"https://openalex.org/keywords/emergency-department-use","display_name":"emergency department utilization","score":0.7699999809265137},{"id":"https://openalex.org/keywords/clinic-attendance","display_name":"clinic attendance","score":0.7059999704360962},{"id":"https://openalex.org/keywords/treatment-adherence","display_name":"medication adherence","score":0.75},{"id":"https://openalex.org/keywords/health-care-access","display_name":"health care access","score":0.6650000214576721},{"id":"https://openalex.org/keywords/health-disparities","display_name":"health disparities","score":0.6359999775886536},{"id":"https://openalex.org/keywords/racial-disparities","display_name":"racial disparities","score":0.3889999985694885},{"id":"https://openalex.org/keywords/black-patients","display_name":"Black patients","score":0.5730000138282776},{"id":"https://openalex.org/keywords/neighborhood-disinvestment","display_name":"neighborhood disinvestment","score":0.5059999823570251},{"id":"https://openalex.org/keywords/redlining","display_name":"redlining","score":0.7649999856948853},{"id":"https://openalex.org/keywords/health-care-utilization","display_name":"health care utilization","score":0.5339999794960022}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8041999936103821},{"id":"https://openalex.org/C205545832","wikidata":"https://www.wikidata.org/wiki/Q17156455","display_name":"Young adult","level":2,"score":0.7103999853134155},{"id":"https://openalex.org/C2778173179","wikidata":"https://www.wikidata.org/wiki/Q25339289","display_name":"Attendance","level":2,"score":0.6747999787330627},{"id":"https://openalex.org/C189326681","wikidata":"https://www.wikidata.org/wiki/Q10294","display_name":"Poverty","level":2,"score":0.49059998989105225},{"id":"https://openalex.org/C74909509","wikidata":"https://www.wikidata.org/wiki/Q10387","display_name":"Gerontology","level":1,"score":0.48989999294281006},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.460999995470047},{"id":"https://openalex.org/C3020110884","wikidata":"https://www.wikidata.org/wiki/Q695416","display_name":"Outpatient clinic","level":2,"score":0.44850000739097595},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.4374000132083893},{"id":"https://openalex.org/C2780724011","wikidata":"https://www.wikidata.org/wiki/Q1295316","display_name":"Emergency department","level":2,"score":0.39590001106262207},{"id":"https://openalex.org/C2777895361","wikidata":"https://www.wikidata.org/wiki/Q1758614","display_name":"Longitudinal study","level":2,"score":0.37689998745918274},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.37040001153945923},{"id":"https://openalex.org/C149923435","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demography","level":1,"score":0.35679998993873596},{"id":"https://openalex.org/C142052008","wikidata":"https://www.wikidata.org/wiki/Q954027","display_name":"Cross-sectional study","level":2,"score":0.3528999984264374},{"id":"https://openalex.org/C12725497","wikidata":"https://www.wikidata.org/wiki/Q810247","display_name":"Baseline (sea)","level":2,"score":0.3375999927520752},{"id":"https://openalex.org/C2780664029","wikidata":"https://www.wikidata.org/wiki/Q5282120","display_name":"Disease burden","level":3,"score":0.3179999887943268},{"id":"https://openalex.org/C137403100","wikidata":"https://www.wikidata.org/wiki/Q41710","display_name":"Ethnic group","level":2,"score":0.31279999017715454},{"id":"https://openalex.org/C2780877353","wikidata":"https://www.wikidata.org/wiki/Q2518253","display_name":"Health services research","level":3,"score":0.30869999527931213},{"id":"https://openalex.org/C2909321700","wikidata":"https://www.wikidata.org/wiki/Q181600","display_name":"Outpatient visits","level":3,"score":0.3025999963283539},{"id":"https://openalex.org/C187212893","wikidata":"https://www.wikidata.org/wiki/Q123028","display_name":"Pediatrics","level":1,"score":0.30239999294281006},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.29589998722076416},{"id":"https://openalex.org/C134362201","wikidata":"https://www.wikidata.org/wiki/Q317309","display_name":"Mental health","level":2,"score":0.287200003862381},{"id":"https://openalex.org/C147077947","wikidata":"https://www.wikidata.org/wiki/Q1515895","display_name":"Socioeconomic status","level":3,"score":0.2865999937057495},{"id":"https://openalex.org/C124306116","wikidata":"https://www.wikidata.org/wiki/Q2512965","display_name":"Ambulatory care","level":3,"score":0.2720000147819519},{"id":"https://openalex.org/C2776534028","wikidata":"https://www.wikidata.org/wiki/Q1141363","display_name":"Medicaid","level":3,"score":0.26489999890327454},{"id":"https://openalex.org/C52130261","wikidata":"https://www.wikidata.org/wiki/Q39825","display_name":"Census","level":3,"score":0.26440000534057617},{"id":"https://openalex.org/C2908647359","wikidata":"https://www.wikidata.org/wiki/Q2625603","display_name":"Population","level":2,"score":0.2597000002861023},{"id":"https://openalex.org/C2250968","wikidata":"https://www.wikidata.org/wiki/Q1512929","display_name":"Health equity","level":3,"score":0.2596000134944916},{"id":"https://openalex.org/C99454951","wikidata":"https://www.wikidata.org/wiki/Q932068","display_name":"Environmental health","level":1,"score":0.25029999017715454}],"mesh":[],"locations_count":1,"locations":[{"id":"pmh:oai:repository.upenn.edu:20.500.14332/62076","doi":null,"is_oa":true,"landing_page_url":"https://repository.upenn.edu/handle/20.500.14332/62076","pdf_url":null,"source":{"id":"https://openalex.org/S4306402083","display_name":"ScholarlyCommons (University of Pennsylvania)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I79576946","host_organization_name":"University of Pennsylvania","host_organization_lineage":["https://openalex.org/I79576946"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"Presentation"}],"best_oa_location":{"id":"pmh:oai:repository.upenn.edu:20.500.14332/62076","doi":null,"is_oa":true,"landing_page_url":"https://repository.upenn.edu/handle/20.500.14332/62076","pdf_url":null,"source":{"id":"https://openalex.org/S4306402083","display_name":"ScholarlyCommons (University of Pennsylvania)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I79576946","host_organization_name":"University of Pennsylvania","host_organization_lineage":["https://openalex.org/I79576946"],"host_organization_lineage_names":[],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"Presentation"},"sustainable_development_goals":[{"score":1.0,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"},{"score":1.0,"id":"https://metadata.un.org/sdg/10","display_name":"Reduced inequalities"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W4390739516","https://openalex.org/W2986709587","https://openalex.org/W4389243419","https://openalex.org/W4404115077","https://openalex.org/W4405044328","https://openalex.org/W4403188120","https://openalex.org/W4405043901","https://openalex.org/W2953900489","https://openalex.org/W4310117631","https://openalex.org/W2989355986"],"abstract_inverted_index":{"Introduction:":[0],"Sickle":[1],"cell":[2],"disease":[3,457],"(SCD)":[4],"is":[5,464],"an":[6],"inherited":[7],"blood":[8],"disorder":[9],"that":[10,439],"results":[11],"in":[12,56,81,119,122,158,267,413,425,433,456,478,480],"severe":[13],"anemia,":[14],"acute":[15],"pain,":[16],"and":[17,21,40,63,71,107,140,191,203,215,249,265,289,340,379,383,411,451],"end-organ":[18],"damage.":[19],"Adolescents":[20],"young":[22],"adults":[23],"(AYA)":[24],"with":[25,53,79,91,94,145,150,315,357,367,386,422,427,461,476],"SCD,":[26,92],"who":[27],"are":[28,34],"primarily":[29],"Black":[30],"or":[31,323],"African":[32],"American,":[33],"especially":[35],"vulnerable":[36],"to":[37,43,45,83,89,97,117,130,154,193,199,258,276,466],"increased":[38],"morbidity":[39],"mortality":[41],"due":[42],"barriers":[44],"care":[46,84,120,218,268,479],"influenced":[47],"by":[48,60],"structural":[49],"racism.":[50],"Many":[51],"AYA":[52,93,144,149,167,293,421],"SCD":[54,95,123,151,423],"live":[55,424],"poverty-stricken":[57],"neighborhoods":[58,426],"shaped":[59],"historical":[61],"redlining":[62],"chronic":[64],"disinvestment.":[65],"Neighborhood":[66,352],"factors,":[67],"such":[68],"as":[69],"poverty":[70,201,353,397],"low":[72],"household":[73,205,313,338],"income,":[74],"have":[75,98],"been":[76],"consistently":[77],"associated":[78,356,385],"disparities":[80,455],"access":[82],"across":[85],"populations.":[86],"In":[87],"contrast":[88],"children":[90],"tend":[96],"higher":[99,428],"emergency":[100],"department":[101],"reliance":[102],"(EDR),":[103],"lower":[104,108],"clinic":[105,138,246,324,368],"attendance,":[106,139],"treatment":[109,141,251,341,387,403],"attendance.":[110],"Yet,":[111],"the":[112,136,164,169,173,184,209,228,279,334,443,471],"pathways":[113],"connecting":[114],"neighborhood":[115,133,213,263,312,337,444,474],"factors":[116,214,264,475],"engagement":[118,266,477],"behaviors":[121],"remain":[124],"under-studied.":[125],"Thus,":[126],"this":[127],"study":[128],"aims":[129],"evaluate":[131],"how":[132],"inequities":[134],"influence":[135],"EDR,":[137,243],"attendance":[142,247,252,325,342,369,388,404],"of":[143,172,180,217,225,402,470],"SCD.":[146,481],"Methods:":[147],"Fifty-seven":[148],"(ages":[152],"16":[153],"25)":[155],"were":[156,189,241,256,274],"enrolled":[157],"a":[159,399,414],"prospective,":[160],"longitudinal":[161],"study.":[162],"On":[163],"baseline":[165,229,304],"survey,":[166],"provided":[168],"full":[170],"address":[171],"home":[174],"at":[175,442],"which":[176],"they":[177,430],"spent":[178],"most":[179],"their":[181],"time":[182],"during":[183],"year":[185],"prior.":[186],"These":[187],"addresses":[188],"geocoded":[190],"linked":[192],"2020":[194],"U.S.":[195],"Census":[196],"tract-level":[197],"data":[198],"obtain":[200],"rate":[202],"median":[204],"income.":[206],"To":[207],"explore":[208,468],"relationship":[210],"between":[211,262,281,311,336,473],"these":[212,282],"patterns":[216],"engagement,":[219],"healthcare":[220],"utilization":[221],"within":[222],"6":[223],"months":[224],"participants":[226],"completing":[227],"survey":[230],"was":[231,307,354,381],"assessed":[232],"via":[233],"electronic":[234],"health":[235],"record":[236],"review.":[237],"Three":[238],"primary":[239],"metrics":[240],"reviewed:":[242],"outpatient":[244,250,434],"hematology":[245],"ratio,":[248],"ratio.":[253],"Pearson":[254],"correlations":[255,261],"used":[257],"assess":[259],"bivariate":[260],"variables.":[269],"Multivariate":[270],"linear":[271,416],"regression":[272,417],"analyses":[273],"conducted":[275],"further":[277,467],"determine":[278],"association":[280,310,366],"variables":[283],"when":[284,406],"controlling":[285,407],"for":[286,408,449],"participant":[287,409],"age":[288,295,410],"gender.":[290],"Results:":[291],"Forty-nine":[292],"(Mean":[294],"=":[296,299,318,321,328,331,347,350,360,363,374,377,391,394],"20.1,":[297],"SD":[298],"2.53;":[300],"40.8%":[301],"Female)":[302],"completed":[303],"procedures.":[305],"There":[306],"no":[308],"significant":[309,400],"income":[314,339],"EDR":[316,358],"(r":[317,327,346,359,373,390],"-.20,":[319],"p":[320,330,349,362,376,393],".209)":[322],"ratio":[326,343,370,389],".13,":[329],".407);":[332],"however,":[333],"correlation":[335],"approached":[344,371],"significance":[345,372],".37,":[348],".072).":[351],"not":[355],".21,":[361],".174),":[364],"its":[365],"-.26,":[375],".092),":[378],"it":[380],"significantly":[382],"negatively":[384],"-.45,":[392],".023).":[395],"Notably,":[396],"remained":[398],"predictor":[401],"even":[405],"gender":[412],"multivariate":[415],"analysis.":[418],"Conclusion:":[419],"When":[420],"poverty,":[429],"engage":[431],"less":[432],"treatments.":[435],"This":[436],"finding":[437],"suggests":[438],"socioeconomic":[440],"disadvantages":[441],"level":[445],"may":[446],"restrict":[447],"opportunities":[448],"consistent":[450],"preventative":[452],"care,":[453],"reinforcing":[454],"management.":[458],"Future":[459],"research":[460],"larger":[462],"samples":[463],"needed":[465],"mechanisms":[469],"associations":[472]},"counts_by_year":[],"updated_date":"2026-10-28T10:33:24.094632","created_date":"2026-03-14T00:00:00"}