Socioeconomic deprivation, disease complications and access to preventive care in sickle cell disease in mainland France

Several studies have assessed the impact of socioeconomic factors on the health of sickle cell patients, yielding heterogeneous results. We conducted a population-based study using a health-insurance database in France to investigate this association, using longitudinal data over a 9-year follow-up time. Socioeconomic factors were assessed using the validated French deprivation index, an area-level index of social disadvantage. The study population comprised 17,315 patients with a median age of 23 years and a median follow-up of 8.1 years. Patients living in the most disadvantaged areas were at greater risk of vaso-occlusive events (VOEs): 70.4% of patients with a median cumulative time of hospitalization of 33.5 days over the study period in the disadvantaged socioeconomic group, compared to 67.9% of patients and 29.9 days in the comparison group (p=0.035 and p<0.001). There was no difference regarding chronic complications, but a trend towards higher mortality in the disadvantaged group (HR: 1.13, 95% CI: 0.94 - 1.36). There was no difference between groups in access to preventive and curative care recommended in mainland France (vaccination, folic acid supplementation, antibiotic prophylaxis, hydroxycarbamide use). These underline the importance of socioeconomic disadvantage, independently of accessibility to healthcare, in the morbidity and mortality of sickle cell patients.