Unveiling Disparities: A Comprehensive Analysis of Priapism in Sickle Cell Disease Admissions Among Adult Males in the United States (2016-2022) Using NIS Database
Authors: Basharat Ahmad , Mumtaz Aqsa , Khan Marjan , Khan Atif N , Naeem Ammad , Aslam Afifa , Nawaz Gul , Shahzad Moazzam 
Published: December 2024

Introduction: Priapism is a common and severe complication of Sickle Cell Disease (SCD) that often necessitates hospitalization. This study analyses the characteristics and outcomes of adult male admissions for priapism within the SCD population in the United States from 2016 to 2022, using data from the National Inpatient Sample (NIS).

Methods: Data from the NIS for the years 2016 to 2022 were extracted, focusing on adult male admissions for priapism among patients with SCD. The study utilized ICD-10 codes to identify cases of SCD (D57.x) and priapism (N48.3). Variables analyzed included race, age, length of stay (LOS), the total cost of hospitalization, geographical region, hospital size, teaching status of the hospital, and primary payer. Statistical analyses were performed to calculate odds ratios (OR) and 95% confidence intervals (CI) to determine the likelihood of priapism admissions across different variables.

Results: The total SCD admissions during the study period were approximately 530,484, with 2.8% (14,853) of these admissions being for priapism. The median age of patients admitted for priapism was 28 years (18-45). The racial distribution was predominantly African American (90%), with other races accounting for 10%. The average length of stay for priapism admissions was 5.4 days (SD: 2.3 days). The average total cost per admission was $18,500 ($12,000-$35,000). Geographically, 25% of admissions occurred in the Northeast, 20% in the Midwest, 40% in the South, and 15% in the West. Regarding hospital size, 10% of the admissions were in small hospitals, 35% in medium hospitals, and 55% in large hospitals. Teaching hospitals accounted for 70% of admissions, compared to 30% in non-teaching hospitals. Primary payer data indicated that 40% of the admissions were covered by Medicaid, 20% by Medicare, 25% by private insurance, and 15% were uninsured or covered by other means.

Odds ratio calculations for the incidence of priapism revealed that African American patients had an odds ratio of 2.8 (95% CI: 2.4-3.2, p &lt; 0.001) compared to other races. Younger patients (18-30 years) had an odds ratio of 1.9 (95% CI: 1.6-2.2, p &lt; 0.001) compared to older patients (31-40 years). Patients in the South had an odds ratio of 1.6 (95% CI: 1.4-1.9, p &lt; 0.01) compared to those in the Northeast. Those admitted to large hospitals had an odds ratio of 1.4 (95% CI: 1.2-1.6, p &lt; 0.01) compared to small hospitals. Patients in teaching hospitals had an odds ratio of 1.7 (95% CI: 1.5-2.0, p &lt; 0.001) compared to those in non-teaching hospitals. Medicaid patients had an odds ratio of 2.1 (95% CI: 1.8-2.4, p &lt; 0.001) compared to those with private insurance.

Conclusion: This study highlights significant disparities in the incidence of priapism among SCD patients across different demographic groups, hospital settings, and geographical regions. Targeted interventions are necessary to improve healthcare delivery and outcomes for this vulnerable population.