Date of Conferral



Doctor of Public Health (DrPH)


Health Services


Roland Thorpe


A small percentage of patients with sickle cell disease (SCD) have experienced an increase in life span by 10 years, while others with the same disease continue to die prematurely. The purpose of the study was to evaluate whether or not regional location was a barrier to care for adults with SCD in relation to emergency department visits and health outcomes at 16 and 21 years after the approval of hydroxyurea therapy as treatment. Secondary data were sourced and a retrospective quantitative correlational design was used to examine the effect of hydroxyurea treatment approval on emergency department visits and mortality (dependent variables) with changes in the regions for Northeast, Midwest, South, and West (independent variables). Insurance status, age, gender, and income level (covariables) were employed to describe the population. Chi-Square analysis was used to examine the association of the variables and sample sizes provided by the HCUP datatsets; Nationwide Inpatient Sample (NIS) 2006 (n=67,214), NIS 2011 (n=80,040), Nationwide Emergency Department Sample (NEDS) 2006 (n=164,698), and NEDS 2011 (n=215,296). The results of the analysis revealed a significant association between regional location, emergency department visits, and deaths among SCD patients. The implications for social change include improvements in health and health outcomes regionally, with adult SCD education for health care providers and patients on SCD treatment protocols. Adults with SCD might possibly benefit from this study with improvements in health and health outcomes for all regions once the barrier to care and specific areas are identified.