Integrating Social Determinants of Health to Advance Understanding of Sickle Cell Disease Pain Outcomes

Background: Pain interference captures the functional impact of pain in sickle cell disease (SCD) and is shaped by clinical and social context. Evidence remains limited on how multilevel social determinants of health (SDOH), including area-level indices, relate to pain interference in adults with SCD. Objective: To characterize demographic, individual-level socioeconomic, and area-level SDOH in a multisite adult SCD cohort and evaluate their associations with PROMIS Pain Interference. Methods: This cross-sectional secondary analysis used baseline data from the Guided Relaxation and Acupuncture for Chronic Sickle Cell Disease Pain (GRACE) pragmatic trial conducted at five U.S. clinical sites (parent cohort N=360). Pain interference was measured using PROMIS Pain Interference T-scores. Predictors were entered hierarchically in three blocks: (1) demographics (age, sex); (2) individual-level socioeconomic indicators (income, education, employment, marital status, insurance); and (3) area-level indicators linked to residential geography (Area Deprivation Index, National Walkability Index, Rural-Urban Commuting Area category, county Black-White segregation, and county Gini). Hierarchical multivariable linear regression models included site fixed effects and ZIP-code-clustered robust standard errors. Clinical covariates were excluded to reduce overadjustment. Complete-case analyses were conducted (analytic N=187). Results: Mean pain interference was 63.88 (SD=5.69), and mean age was 36.98 years (SD=11.19); 68.3% were female, and 98.1% reported Black/African American race. In the fully adjusted model, older age was associated with higher pain interference (β=0.0935, SE=0.0315, p=.004). Part-time employment (vs full-time) was associated with lower pain interference (β=−3.025, SE=1.254, p=.017). Income, education, marital status, insurance, and all area-level indices were not independently associated with pain interference in the fully adjusted model. Model fit increased modestly across blocks (R²=0.063 in Model 1; 0.108 in Model 2; 0.114 in Model 3), and the area-level block added minimal incremental explanatory value. Conclusions: In this multi-site adult SCD cohort, age and employment status showed the most consistent associations with pain interference within a multilevel SDOH framework that excluded clinical covariates. Area-level indices were not independently associated in the fully adjusted model and contributed little incremental explained variance. Findings support function-centered assessment and SDOH-informed care processes that address economic stability constraints.

Author dc:creator

• Juanita E. Darby (24400256)

• Sickle Cell Disease
• Pain Interference
• Chronic Pain
• Social Determinants of Health
• Patient-Centered Outcomes
• Health Disparities
• Pragmatic Clinical Trials

Statement dc:rights

• In Copyright
• Open Access after 2028-05-01

DOI dc:identifier

https://doi.org/10.25417/uic.32995304.v1

OAI identifier oai:identifier

oai:figshare.com:article/32995304