Health equity in sickle cell disease: overcoming barriers to care in marginalized communities

Abstract

Sickle cell disease (SCD) is one of the most prevalent inherited blood disorders globally, disproportionately affecting populations of African, Mediterranean, Middle Eastern, and South Asian ancestry. Despite advances in newborn screening, disease-modifying therapies, and curative interventions, profound disparities persist in diagnosis, treatment access, and survival outcomes. This narrative review examines the structural, socioeconomic, and healthcare barriers to equitable SCD care in marginalized communities and synthesizes policy-relevant strategies to overcome these obstacles. A structured narrative review was conducted by searching PubMed, Scopus, Web of Science, CINAHL, and Google Scholar for literature published between 2010 and 2025. Peer-reviewed articles, policy briefs, and global health reports addressing SCD and health equity were included, with thematic synthesis used to identify key barriers and interventions. Evidence reveals that poverty, inadequate health infrastructure, systemic racism, stigma, and fragmented care systems remain major drivers of inequity. Limited access to newborn screening, hydroxyurea, transfusion programs, and curative therapies perpetuates preventable morbidity and mortality, particularly in sub-Saharan Africa and underserved diaspora communities. Promising interventions include universal newborn screening, community-based education, task-sharing with trained health workers, equitable research funding, and integration of telemedicine to improve specialist access. Health equity in SCD requires more than biomedical innovation. Sustainable progress depends on dismantling structural barriers, strengthening healthcare systems, and implementing policies that prioritize social determinants of health. Coordinated global and local action can transform SCD care from a paradigm of persistent disparity into a model of equitable, patient-centered outcomes.

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