Economic Disparities in the Outcomes of Sickle Cell Disease-Related Admissions over a Decade

Background:

According to the CDC, Sickle Cell Disease (SCD) occurs in 1 out of every 365 African American births and 1 out of every 16,300 Hispanic American births. It is an inherited disorder caused secondary to a mutation in the hemoglobin beta subunit and has complex phenotypes. The disease is characterized by recurrent hemolysis, vaso-occlusion leading to pain episodes, and chronic organ damage due to ischemia. A comprehensive care management team is not well established for this disease. There is sparse information regarding the trends in outcomes of SCD admissions in the past decade where rapid advances have been made in treatment including the evolving hematopoietic stem cell transplant. In this study, we sought to analyze the trends and outcomes of SCD admissions in the United States from 2011- 2019 and the influence of socioeconomic status.

Methods:

The National Inpatient Sample (NIS) database was queried to identify adult patients admitted with a principal diagnosis of Sickle Cell Disease using the International Classification of Disease (ICD-9) and ICD-10 codes. Trends for primary in-hospital outcomes including mortality, length of stay (LOS), and total hospitalization charges (THC) were assessed. The impact of economic status on these outcomes was also studied. Statistics were performed using STATA and multivariate linear and logistic regression analysis was used to adjust for confounders.

Results:

The rate of hospitalizations for SCD remained stable from 2010 to 2019. Women constituted 53.99% and the majority of patients were young adults (86.62%) and Black (90.36%) as expected. Many patients belonged to the low-income quartile group and were admitted to hospitals with a large bed size and urban teaching hospitals.

The overall mortality rate among adult SCD hospitalizations from 2010 to 2019 decreased by an odds ratio of 0.96 (p=0.008) after adjusting for age, sex, and race and is reassuring. However, on subgroup analysis, this trend was replicated for those belonging to a higher income quartile group whereas there was no statistically significant decrease in the mortality rate trend for those belonging to the lower income quartile group.

After adjusting for confounders there was an increase in the total charges in all subgroups (p<0.001). The mean LOS decreased for the total population and most subgroups (p<0.001).

Conclusion:

Despite the advances in the understanding of SCD and its treatment, its benefits have not reached all the people affected. Access to healthcare and the treatment costs associated could be one among the possible reasons why the lower income quartile group have not yet benefited. Meaningful progress in healthcare is not achievable unless these economic disparities are addressed. It is imperative to develop economic policies to address these inequities.

No relevant conflicts of interest to declare.