Introduction Social determinants of health (SDoH), such as economic hardship, housing insecurity, and healthcare access, drive outcomes in sickle cell disease (SCD). Frequent emergency department (ED) utilization reflects unmet social needs and fragmented care. Assessing adverse SDoH and ED links is crucial for interventions. We conducted a systematic review and meta-analysis on adverse SDoH and increased ED utilization in SCD.

Methods We Searched PubMed, Embase, and Google Scholar through August 2025 for SCD, SDoH, and ED keywords. Binary random-effects model was used to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Leave one out sensitivity analysis was performed. Heterogeneity was assessed using I2 statistics. A p<0.05 was considered statistically significant.

Results From 29 screened studies, seven met inclusion criteria, with four undergoing full-text extraction, yielding eight effect estimates across 10,234 patients with sickle cell disease (SCD; mean age ~34.4 years).The primary outcome was ED admissions and readmissions. Evaluated social determinants of health (SDoH) included financial insecurity, poverty level, neighborhood vulnerability, and healthcare access barriers. Meta-analysis revealed adverse SDoH significantly associated with increased emergency department (ED) utilization (pooled odds ratio [OR] 3.11, 95% CI: 1.47–6.60, p<0.001).Initial high heterogeneity stemmed from variances in study designs, populations, and SDoH definitions; post-outlier exclusion and outcome harmonization reduced it to (I²=0.92%), . Leave-one-out sensitivity analyses confirmed consistency.

Conclusion SCD exposed to adverse SDoH is associated with increase ED Utilizations. There is 211% increased odds which explains the importance of integrating SDoH screening into routine clinical care. Limitations include reliance on observational studies, and potential residual confounding from unadjusted factors due to differences in population and healthcare settings. Broader policy efforts are needed to address social inequities in SCD management.Prospective studies are needed to confirm causality and assess the impact of social interventions on reducing ED use in SCD

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2025
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