Respiratory phenotype and healthcare utilization patterns by adults with sickle cell disease

• There is an identifiable cohort of adults with SCD who have clinical encounters with documented respiratory symptoms without asthma.

• Intermittent respiratory symptom status is associated with significantly increased healthcare utilization

Adults with sickle cell disease (SCD) and asthma have increased mortality and health care utilization, however there are individuals with respiratory symptoms (including cough and wheeze) without asthma. These individuals may have similar patterns of increased mortality and healthcare utilization. Objective is to characterize the association between respiratory phenotype and healthcare utilization by adults with SCD. Cross-sectional study of adults with SCD presenting for emergency and inpatient hospital care from 2012-2014 in Florida, Iowa, and New York using state level healthcare utilization databases. Outcomes of interest All-cause, SCD-related, painful episode, and ACS related care. Respiratory phenotype was defined as SCD + Asthma, SCD + Respiratory symptoms, and SCD + none. We built multivariable logistic regression and negative binomial regression models to evaluate the association adjusting for demographics, social determinant of health proxies, year of care, and state. Of 29,952 identified individuals, 3.4% had intermittent respiratory symptoms and a larger proportion (15.6%) had asthma. There was a high rate of inpatient hospitalizations (43%)) and ED visits (60%). Compared to individuals with intermittent respiratory symptoms, Individuals with asthma had a higher annual risk of inpatient hospitalizations (48% vs. 37%) but lower annual risk of an ED visit (62% vs. 86%). The pattern of increased healthcare utilization amongst individuals with intermittent respiratory symptoms was consistent across each utilization type. In this large cohort adults with SCD we identified some with intermittent respiratory symptoms who had significantly increased healthcare utilization. This warrants further evaluation to understand potential etiologies and interventions.