Abstract 4373367: Perceived Discrimination from Healthcare Providers Among Individuals With and Without Sickle Cell Disease Who Have Suffered a Stroke

Introduction: An estimated 100,000 individuals in the United States have sickle cell disease (SCD). Strokes and silent cerebral infarcts occur in approximately 60% of adult aged 18-30 with sickle cell anemia, the most severe form of SCD, which can lead to functional impairments, issues with school and work performance, and premature death. The rate of stroke recurrence has been reported as 14% in prior studies. SCD occurs in individuals of African descent in 90% of cases, and the quality of care for these individuals is impacted by racial bias, stigma, and implicit bias. The objective of this study was to investigate differences in perceived discrimination from doctors and nurses between individuals with and without SCD who have suffered a stroke or similar neurological event (i.e., transient ischemic attack (TIA), paralytic syndrome related to stroke, residual cognitive deficit due to stroke, etc.). Methods: From the All of Us Research Program, we used the Observational Medical Outcomes Partnership Common Data Model to identify all patients with a diagnosis (standard concept name) indicating sickle cell disease (SCD) who also had a diagnosis indicating a stroke or similar neurological event. We also identified individuals with a self-reported history of stroke or TIA using survey data. Propensity score matching was used to create a control group of individuals with no history of SCD who have had a stroke or similar event and who had similar demographic characteristics to the SCD individuals. We ran Welch’s t-tests and logistic regression modeling to assess for differences in responses between the SCD group and control group to the six survey questions indicating perceived discrimination from doctors or nurses. All analyses were completed in Python 3. Results: A total of 128 individuals with SCD self-reported a history of stroke or TIA. With matched controls, the total sample was 256 individuals. For each of the six survey questions, the p-value from the t-test was less than 0.001. The p-value of the log-likelihood ratio from the logistic regression was also less than 0.001. The only significantly different survey question asked if the patient felt they were treated with less courtesy at the doctor’s office. Conclusion: Among individuals who have suffered a stroke or similar neurological event, those with SCD reported significantly more perceived discrimination from doctors and nurses.