Hospital Utilization in Sickle Cell Disease Patients: A One-Year Retrospective Study in Urban Underserved Communities

Introduction

Sickle cell disease (SCD) is a common genetic disorder affecting approximately 100,000 people in the United States. It significantly reduces quality of life and leads to early death. Despite available FDA-approved medications that can reduce painful episodes, these treatments are often under prescribed due to healthcare access barriers, socioeconomic challenges, and psychosocial factors. This study examines how these factors impact healthcare use among SCD patients at NYCHHC/Lincoln Medical Center.

Method

We reviewed records of SCD patients admitted to Lincoln Medical Center between January 1 and December 31, 2022. We collected data on emergency department (ED) visits, hospital admissions, average length of stay (LOS), medication, and psychiatric disorders from electronic medical records. Data analysis was performed with SPSS.

Results

We identified 30 patients, and 2 who died within a year of their first 2022 admission were excluded. The remaining 28 patients accounted for 105 admissions during the study period. Of these patients, 21.4% were male (N=6) and 78.6% were female (N=22). The majority identified as Black (75%), while 25% identified as Hispanic. The average age was 20.3 years.

Black patients, compared to Hispanic patients, had more ED visits (13.5 vs 4.6, p=0.101), more readmissions (4.2 vs 2.4, p=0.052), and longer LOS (5.3 vs 3.0 days, p=0.267).

Regarding medication use, 78.6% of patients (N=24) were taking Hydroxyurea, 3.6% (N=1) were receiving Voxelotor, and 7.1% (N=2) were enrolled in the clinical trial (Etavopivat). Patients on FDA-approved SCD medications (Hydroxyurea and Voxelotor in our case) had fewer readmissions (2.17 vs 4.18, p=0.011) to compared to who were not.

In terms of healthcare provider access, 21.4% of patients lacked a primary care provider (PCP), and 28.6% lacked a hematologist for SCD follow-up. Patients without hematologist follow up had more ED visits (24.75 vs 5.85, p<0.001), more readmissions (5.75 vs 2.95, p=0.013), and longer LOS (5.9 vs 4.3 days, p=0.045).

Regarding insurance, 20 patients (71.3%) used Medicare or Medicaid as their primary payer, and 8 (28.6%) had private insurance. There was no statistically significant difference in ED visits, readmissions, or LOS between the insurance groups.

Psychiatric disorders were diagnosed in 28.6% of patients (N=8). These patients had more readmissions (27.7 vs 5.8, p=0.015), more ED visits (9.29 vs 1.9, p=0.015), and longer LOS (8.2 vs 3.6 days, p<0.001) compared to those without psychiatric diagnoses.

Discussion

Our study highlights key insights into healthcare use among SCD patients in an urban underserved community. Black patients had more frequent ED visits, readmissions, and longer hospital stays than Hispanic patients, reflecting disparities in healthcare access, socioeconomic status, and potential treatment biases.

Psychiatric disorders significantly influenced healthcare utilization, with conditions like depression, bipolar disorder, and anxiety leading to higher readmission rates, more ED visits, and longer hospital stays. This underscores the need for integrated mental health services within SCD management.

Despite the high prescription rate of Hydroxyurea, the use of newer FDA-approved medications like Voxelotor and participation in clinical trials were minimal. Given that patients on FDA-approved treatments had fewer readmissions, optimizing pharmacological management is crucial.

The study also highlights the importance of consistent follow-up care. Patients without regular hematologist follow-up experienced significantly higher ED visits, readmissions, and longer LOS, emphasizing the need for continuous care relationships with both primary care providers and specialists.

Conclusion

The study highlights the substantial hospital use burden among SCD patients, characterized by frequent ED visits and readmissions. Despite known benefits, usage of Hydroxyurea and newer FDA-approved medications was suboptimal. Lack of regular hematologist follow-up and presence of psychiatric disorders were associated with increased healthcare utilization. These findings emphasize the need for improved access to hematology follow-up and integrated psychiatric care, to enhance the quality of life for SCD patients.

No relevant conflicts of interest to declare.