Pain related to sickle cell disease (SCD) is multifaceted and associated with many social determinants of health. Although patients with SCD can experience a plethora of complications, pain is a manifestation of the disease that uniformly leads to poor outcomes and quality of life.

Research published in JAMA Network Open by Kelly M. Harris, PhD, of the department of occupational therapy and surgery at Washington University in St. Louis, Missouri, has uncovered new insights into the social determinants of SCD-related pain.

In this cross-sectional study, the researchers explored the association of educational attainment, employment status, and mental health with pain episode frequency and severity among individuals with SCD. They collected and analyzed data from patients treated at 8 sites within the US Sickle Cell Disease Implementation Consortium between September 2020 and March 2022.

The study included a total of 2,264 participants aged 15 to 45 years. Approximately half of the participant cohort reported taking daily pain medication (47.0%) or hydroxyurea use (49.2%).

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In addition, 28.0% of participants received regular blood transfusions, 20.0% had a depression diagnosis, 79.8% had severe pain, and 47.8% had greater than 4 pain episodes in the last 12 months.

Associations of Education, Employment, and Mental Health

After multivariable analysis, the researchers found that educational attainment and income were not associated with higher pain frequency or severity. However, female sex (beta-value, 1.78; 95% CI, 0.80-2.76; P <.001) and unemployment (beta-value, 2.13; 95% CI, 0.99-3.23; P <.001) were associated with higher pain frequency.

In addition, age younger than 18 years was inversely associated with pain frequency (beta-value, −5.72; 95% CI, −7.72 to −3.72; P <.001) and severity (beta-value, 5.10; 95% CI, −6.70 to −3.51; P <.001). Dr Harris and her colleagues also reported that depression was linked with higher pain frequency (beta-value, 2.18; 95% CI, 1.04 to 3.31; P <.001), but not pain severity.

With respect to medication use, hydroxyurea was associated with higher pain severity (beta-value, 1.36; 95% CI, 0.47 to 2.24; P =.003), while daily use of pain medication was associated with both higher pain frequency (beta-value, 6.29; 95% CI, 5.28 to 7.31; P <.001) and severity (beta-value, 2.87; 95% CI, 1.95 to 3.80; P <.001).