Evaluating Trends in Hospitalization, Associated Costs and Racial/Socioeconomic Disparities Among Patients with Sickle Cell Disease Using the National Inpatient Sample (NIS) Database
Authors: Devi Amirta , Kumar Arun , Shah Ghulam , Solangi Zeeshan , Agudile Emeka P. , Solangi Ahda , Sah Ranjit , Diltz Garrett , Latif Hira 
Published: December 2024

Background:

Sickle cell disease (SCD) is a hemoglobinopathy predominantly affecting African Americans and Hispanics, which can lead to frequent vaso-occlusive crisis and other complications which necessitate hospitalization. This study investigated trends in admissions for SCD, associated costs, and patient demographics within the US healthcare system from 2011 to 2019.

Methods:

We queried the NIS database for adult patients age ≥ 18 years with SCD admitted between January 2011 and December 2019. ICD diagnosis codes were used to identify all patients with a primary diagnosis of SCD with admissions for pain crisis, acute chest syndrome, and splenic sequestration. This included patients with sickle cell thalassemia, HbSS disease, sickle cell/Hb-C disease, and other sickle cell variants.

Analyses were performed using Stata version 15.1. Appropriate discharge weights were applied to the dataset during the analyses to account for critical elements of sampling design. A p-value of &lt;0.05 was considered statistically significant.

Results:

The absolute number of admissions and discharge rate for SCD-crisis per 10,000 admissions increased significantly from 2011 to 2019. The discharge rate increased from 25 in 2011 to 29.32 in 2019 per 10,000 admissions (p&lt;0.001). The average length of stay decreased from 4.97 days in 2011 to 4.62 days in 2019, while hospital charges significantly increased by 23.1% after adjusting for inflation (p&lt;0.001). The total aggregate cost (“national burden”) for hospitalizations with SCD-crisis also increased from $1.07 billion in 2011 to $1.20 billion in 2019 (inflation adjusted) (P &lt; 0.001).

We identified that African American and Hispanic patients had highest admissions 93.6% and 3.5% in 2019 and showed increasing discharge rates, while White and Asian/Pacific Islander (API) patients showed lower admissions 1% and 1.87% in 2019 and decreasing discharge rates consistent with overall trends from 2011 to 2019. Highest discharge rates were observed in age groups 18-44 followed by 45-64. Mortality rates showed a decrease which was statically non-significant.

Most patients had Medicaid (45.1%) as primary insurance, followed by Medicare (31.8%) and Private insurance (16.8%) with a small number of self-pay patients (6.2%). Medicaid and private insurance groups had increasing discharge rates, while Medicare and self-pay groups had decreasing rates. The increase in discharge (and admission) rates was most significant among the lowest income groups.

Conclusions:

This study identified a significant increase in hospital admissions and costs for SCD crisis between 2011 and 2019, despite a decrease in length of stay. We also found racial and socioeconomic disparities with the highest burden of admissions concentrated among African Americans, Hispanics, and patients in the lowest income group. Further research is needed to understand the drivers of rising costs and identify strategies to improve access to outpatient care in SCD management.