title: The Association between Educational Attainment and Patterns of Emergency Department Utilization among Adults with Sickle Cell Disease.
abstract: Patients with low educational attainment may be at increased risk for unplanned health care utilization. This study aimed to determine what factors are related to emergency department (ED) visits in hopes of guiding treatments and early interventions.
  
  
  
  At two medical centers in the Mid-Atlantic United States, 258 adults with sickle cell disease aged 19-70 years participated in a retrospective study where we examined whether education level is independently associated with ED visits after accounting for other socioeconomic status (SES) variables, such as pain and disease severity and psychosocial functioning.
  
  
  
  The data showed that patients without a high school education visited the ED three times as frequently as patients with post secondary education. Controlling for poverty and employment status decreased the effect of education on ED visits by 33.24 %. Further controlling for disease severity and/or psychosocial functioning could not account for the remaining association between education and ED visits, suggesting that education is independently associated with potentially avoidable emergency care.
  
  
  
  Early interventions addressing disparities in academic performance, especially for those children most at risk, may lead to improved long-term health outcomes in this population.
authors.affiliation: School of Medicine, University of Pittsburgh, 230 McKee Pl, Suite 600, Pittsburgh, PA, 15213, USA. jonassaintcr@upmc.edu.
authors.forename: C R
authors.initials: CR
authors.lastname: Jonassaint
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Beach
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Haythornthwaite
authors.affiliation: Department of Psychology, University of Maryland, Baltimore County, Baltimore, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Bediako
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Diener-West
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Strouse
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: S
authors.initials: S
authors.lastname: Lanzkron
authors.affiliation: School of Medicine, University of Pittsburgh, 230 McKee Pl, Suite 600, Pittsburgh, PA, 15213, USA.
authors.forename: G
authors.initials: G
authors.lastname: Onojobi
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: C P
authors.initials: CP
authors.lastname: Carroll
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: C
authors.initials: C
authors.lastname: Haywood
mesh_terms: D000328:Adult; D000368:Aged; D000755:Anemia, Sickle Cell / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty; D012189:Retrospective Studies; D012923:Social Class; D055815:Young Adult
keywords: Blood disorders; Chronic illness; Education; Emergency care; Health care utilization; Health disparities; Sickle cell disease; Socioeconomic status
references.citation: J Sch Health. 2005 Sep;75(7):255-66
references.pmid: 16102088
references.citation: Public Health Rep. 2003 Jan-Feb;118(1):27-36
references.pmid: 12604762
references.citation: Int J Behav Med. 2005;12(3):171-9
references.pmid: 16083320
references.citation: Cold Spring Harb Perspect Med. 2012 Sep 01;2(9):a011692
references.pmid: 22951448
references.citation: Adv Sch Ment Health Promot. 2013;6(1):5-20
references.pmid: 23459502
references.citation: Psychosom Med. 2001 Sep-Oct;63(5):850-8
references.pmid: 11573035
references.citation: Neurology. 2001 Apr 24;56(8):1109-11
references.pmid: 11320190
references.citation: Am J Hematol. 2010 Oct;85(10):797-9
references.pmid: 20730795
references.citation: Am J Public Health. 2009 Aug;99(8):1431-7
references.pmid: 19542034
references.citation: J Pediatr Psychol. 2004 Jan-Feb;29(1):7-17
references.pmid: 14747361
references.citation: Pediatr Blood Cancer. 2011 Mar;56(3):413-9
references.pmid: 21225920
references.citation: Ann Fam Med. 2007 Jan-Feb;5(1):21-8
references.pmid: 17261861
references.citation: JAMA. 2010 May 12;303(18):1823-31
references.pmid: 20460621
references.citation: South Med J. 1993 Apr;86(4):397-402
references.pmid: 7682015
references.citation: J Chronic Dis. 1985;38(6):495-505
references.pmid: 4008590
references.citation: Am J Prev Med. 2010 Apr;38(4 Suppl):S536-41
references.pmid: 20331955
references.citation: Pediatr Blood Cancer. 2009 Jan;52(1):92-6
references.pmid: 19006248
references.citation: Ann Behav Med. 2000 Spring;22(2):149-57
references.pmid: 10962708
references.citation: Am J Hematol. 2009 Oct;84(10):666-70
references.pmid: 19743465
references.citation: Sociol Health Illn. 2011 Mar;33(3):465-83
references.pmid: 21375541
references.citation: Ann Intern Med. 2008 Jan 15;148(2):94-101
references.pmid: 18195334
references.citation: J Sch Nurs. 2006 Dec;22(6):330-5
references.pmid: 17121443
references.citation: Ann Behav Med. 1997 Spring;19(2):171-8
references.pmid: 9603692
references.citation: J Rural Health. 2000 Winter;16(1):43-55
references.pmid: 10916314
references.citation: Ann Emerg Med. 2009 May;53(5):587-93
references.pmid: 18926599
references.citation: Eur J Public Health. 2012 Aug;22(4):550-5
references.pmid: 21908859
references.citation: Arch Pediatr Adolesc Med. 2003 Jan;157(1):104
references.pmid: 12517203
references.citation: J Sch Health. 2006 Jan;76(1):33-7
references.pmid: 16457683
references.citation: JAMA. 2010 Apr 7;303(13):1288-94
references.pmid: 20371788
references.citation: BMJ. 1999 Jun 12;318(7198):1585-90
references.pmid: 10364116
references.citation: Am J Hematol. 2006 Dec;81(12):927-32
references.pmid: 16924648
references.citation: N Engl J Med. 1994 Jun 9;330(23):1639-44
references.pmid: 7993409
references.citation: Public Health Rep. 1997 Jan-Feb;112(1):44-51
references.pmid: 9018288
references.citation: J Aging Health. 1993 May;5(2):179-93
references.pmid: 10125443
references.citation: J Pediatr. 2001 Sep;139(3):391-7
references.pmid: 11562619
references.citation: Pediatr Blood Cancer. 2012 Jan;58(1):66-73
references.pmid: 21360655
references.citation: Soc Sci Med. 2010 Jun;70(12):2036-44
references.pmid: 20385437
references.citation: J Natl Med Assoc. 2007 Mar;99(3):192-6
references.pmid: 17393942
references.citation: Am J Prev Med. 2010 Apr;38(4 Suppl):S512-21
references.pmid: 20331952
references.citation: Behav Res Ther. 2000 Sep;38(9):951-63
references.pmid: 10957829