Advisory Committee Chair
Emily Levitan
Advisory Committee Members
Bertha Hidalgo
Brandi Pernell
Document Type
Thesis
Date of Award
1-1-2025
Degree Name by School
Master of Science in Public Health (MSPH) School of Public Health
Abstract
Sickle cell disease (SCD) patients experience high levels of transportation insecurity. Missed or delayed medical care due to transportation barriers can result in worsened clinical outcomes and increased hospital admissions and emergency department (ED) visits. We hypothesized that the relationship between transportation insecurity and acute care utilization is partially mediated by no-show appointments. This retrospective cohort study included 101 SCD patients aged ≤ 21 treated through the Pediatric Sickle Cell Clinic at Children’s of Alabama (COA) hospital from 2023 to 2024 and completed a social determinants of health (SDoH) questionnaire. Negative binomial or Poisson regression was used to model ED visitation and hospital admissions by transportation insecurity status. Inverse odds ratio weighted (IORW) mediation was used to examine whether no-show appointments mediate the relationship between transportation insecurity and acute care utilization before and after adjusting for financial resource strain. Transportation insecure participants exhibited more frequent no-show appointments and hospitalizations. Transportation insecurity was associated with a 56% higher incidence of unscheduled hospitalization in the unadjusted mediation model (95% CI [1.12 – 2.09]) and a 65% higher incidence after adjusting for financial resource strain (95% CI [1.17 – 2.28]). Significant indirect effects of transportation insecurity on hospitalization through no-show appointments were observed in the unadjusted (IRR = 1.17, 95% CI [1.00 – 1.60]) and adjusted models (IRR = 1.37, 95% CI [1.05 – 2.14]). The proportion mediated by no-show appointments was 39.7% in the unadjusted model and rose to 68.5% after adjusting for financial resource strain. Transportation insecurity increased the incidence of ED visits by 75% in the unadjusted model (95% CI [1.05 – 2.78]) and 73% in the adjusted model (95% CI [1.01 – 2.76]). However, indirect effects were not significant the unadjusted (IRR = 1.06, 95% CI [0.81 – 1.68]) or adjusted models (IRR = 1.37, 95% CI [0.96 – 2.31]), for which the proportions mediated were 12.6% and 63.4%, respectively. No-show appointments mediated the relationship between transportation insecurity and hospitalization, even after adjusting for financial resource strain. Understanding the role of transportation insecurity in predicting no-show appointments and acute care utilization in pediatric SCD patients is necessary to promote adherence to outpatient care and improve health outcomes.
Recommended Citation
Jeffcoat, Seabrook Hannah, "The Impact of Transportation Insecurity on No-Show Appointments and Acute Care Utilization in Pediatric Sickle Cell Patients" (2025). All ETDs from UAB. 6849.
https://digitalcommons.library.uab.edu/etd-collection/6849
Comments
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