Electronic Theses and Dissertations

Date

2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Public Health

Committee Chair

Matthew Smeltzer

Committee Member

Meredith A Ray

Committee Member

Abu Mohammed Naser Titu

Committee Member

Amanda J Young

Abstract

Sickle cell disease (SCD) is an inherited blood disorder. Normal red blood cells are round. In those with SCD, the red blood cells are crescent shaped. In the Unites States (US), more than 90% of those living with SCD are Black. We conducted three epidemiological studies related to the burden of common comorbidities in individuals with SCD, the relationship between SCD and chronic kidney disease, and the effects of historical racial housing policies on births with SCD. First, we evaluated the annual incidence and demographic associations of stroke, seizures, congestive heart failure, asthma, systemic hypertension, and diabetes mellitus in individuals living with SCD. Older individuals with SCD had higher odds of stroke, seizures, congestive heart failure, systemic hypertension, and diabetes mellitus compared to those under the age of 18. Females with SCD had 1.66 (95% CI: 1.13, 2.44) times the odds of incident diabetes mellitus compared to males. Individuals living with SCD in rural Tennessee had 2.05 (95% CI: 1.14, 3.68) times the odds of incident congestive heart failure compared to urban dwellers. Next, we evaluated the incidence, demographic associations, and mortality in individuals with SCD who had chronic kidney disease (CKD). Compared to those under 18 years of age, those above 45 had 23.54 (95% CI: 7.07, 78.36) times the odds of incident CKD. In terms of mortality, individuals with SCD who had CKD, had statistically significant lower mean age of death compared to the general US population (53 years vs. 73.7 years, p-value 0.0485). The final analysis estimated the burden of births with SCD in historically redlined Zip codes along with modern-day economic implications. A higher proportion of newborns with SCD (32%) were born in historically redlined Zip codes compared to the general population (15%) of the state. There were similar findings for three (Shelby, Davidson, and Hamilton) of the four major counties. There was also a statistically significant association between births with SCD and living in a previously redlined Zip code (p-value 0.0012). In terms of modern-day economic implications, there were no significant associations between births with SCD and median household income.

Comments

Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to ProQuest.

Notes

Embargoed until 4/5/2025

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Available for download on Saturday, April 05, 2025

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