Social
The Association Between Early Life Social Determinants and Adult Morbidity in a Jamaican Sickle Cell Disease Cohort Alphanso Lorenzo Blake* Alphanso Blake Blake Blake Blake Blake Blake The School of Clinical Medicine and Research, The Bahamas, The University of the West Indies, Nassau, The Bahamas
Genotype plays a major role in Sickle Cell Disease (SCD) severity; however, the role of early-life exposures remains unclear. This study evaluates the association between early-life exposures and adult complications in Jamaicans living with SCD.
Retrospective data on newborns with SCD in the 1973 – 1981 Jamaica Sickle Cell Cohort Study were analysed. Early life exposures including birth weight, household structure, social amenities scores (SAS) and parental occupation classification (by the International Standard Occupational Classification), were evaluated against physician-diagnosed leg ulcers, acute chest syndrome (ACS) and chronic kidney disease (CKD). Using Stata 19, binary logistic regression models assessed the strength and direction of associations and ROC curves and Hosmer-Lemeshow tests assessed the goodness of fit. Complete case analysis handled missing data. Ethical approval was granted by the Mona Campus Research Ethics Committee.
In a sample of 535 persons (52% males), haemoglobin (Hb) SS (56.5%) and HbSC (31.4%) were the dominant genotypes. No sex differences between SCD genotypes and early life exposure groups were seen. Leg ulcers (25.1%) were more common (p=0.01) in males (30.0%) vs females (19.8%), while ACS (23.5%) and CKD (9.5%) showed no sex differences. In multivariable models, CKD showed no association with exposures; however, persons with higher birthweight had 23% reduced odds of ACS (OR(95%CI)=0.77(0.61 – 0.96), p=0.019). Leg ulcers were 44% less likely in females (OR(95%CI)=0.56(0.33 – 0.92), p=0.024), 57% less likely in persons in SAS tertile 3 vs 1 (OR(95%CI)=0.43(0.22 – 0.83), p=0.013) and 77% more likely in those with parental occupation skill level 2 (OR(95%CI)=1.77(1.01 – 3.10), p=0.046) vs 1.
Birthweight, sex and SAS are non-clinical factors which significantly influence adult SCD complications. Early interventions targeting vulnerable groups may help reduce long-term morbidity and improve outcomes in SCD populations