Balancing the Blade: Opioid Access and Management Challenges in Sickle Cell Disease - a Study from the National Inpatient Sample Database (2015-2020)
Authors: Sanjeevi Aditya , Vijay Rao Aniket , Jose Domench Daniel Idoate , Eltaher Basant , Bhandari Samikchhya Keshary 
Published: December 2024

Objectives: The current study has the following objectives: first, to establish the burden of hospitalizations for opioid-related events in patients with SCD compared to other patients during the period 2015-2020 using data from the National Inpatient Sample (NIS). This study will compare demographic characteristics, comorbidities, and inpatient hospitalization outcomes for opioid-related admissions in patients with and without SCD.

Methods: Retrospective analysis based on the National Inpatient Database since 2015 to 2020 using the ICD codes to code for opioid related hospital admissions, sickle cell disease and comorbidities. Because the NIS data are de-identified, the use of these data is considered exempt from Institutional Review Board (IRB) approval. We utilized the discharge weight provided in the database, and by doing so, DISCWT based national estimates were generated. Pearson Chi-square test was carried out for comparison of categorical variables and independent sample t-tests or one-way ANOVA for continuous variables between the different groups at baseline for demographics and hospital characteristics. Multivariate logistic regression analysis was done after adjusting for demographic variables and comorbidities to obtain adjusted odds ratio (aOR) for hospitalization outcomes.

Results: From 2015 to 2020, we captured 381,035 opioid-related hospitalizations; 825 (0.22%) of these patients were represented by the population with SCD. The median patient age between the two arms were similar: 36 years for non-SCD versus 37 years for SCD. More females were seen in the SCD population as compared to the non-SCD group: 57.58% versus 37.53%, p&lt;0.001. There was a marked difference concerning race: 89.94% in SCD were African-American, whereas in non-SCD, the percentage was only 17.27%, p&lt;0.001. SCD patients were more likely to have comorbidities such as chronic lung disease (29.09% vs. 15.81%, p&lt;0.001), diabetes (8.48% vs. 6.42%, p=0.015), congestive heart failure (4.24% vs. 1.59%, p&lt;0.001), anemia (4.24% vs. 1.31%, p&lt;0.001), neurological disorders (8.48% vs. 5.84%, p=0.001). Concerning the in-hospitalization results, a trend of no significant between-group difference was demonstrated for mortality (0% for SCD vs. 0.03% for non-SCD, p=0.6247). Meanwhile, more SCD patients suffered from acute kidney injury (4.85% vs. 2.26%, p-value &lt;0.001). However, adjusted outcomes revealed that this did not reach statistical significance, aOR 1.373, (95% CI 0.93-2.01 p=0.1042), whereas the LOS was the same between the groups, having a median of 3 days, IQR 2-5, p=1.00. The total hospitalization cost for SCD patients was higher, with a median of $3,893.63, compared to $3,285.53, for non-SCD patients. The disposition post-hospitalization differed- the occurrence of need for home health care post-discharge was greater among the SCD patients, at 3.03% versus 1.23%, with p&lt;0.001. The number of opioid-related hospitalizations on an annual basis during the period of this study for SCD patients showed fluctuation. There were 45 admissions (0.20%) in 2015, increasing till peaking in 2017 with 215 admissions (0.25%) and, thereafter, decreased to 85 admissions (0.19%) in 2020. During this period, the proportion of admissions due to opioid-related hospitalizations in patients with SCD remained fairly stable.

Conclusion: The comorbidity burden and hospitalization costs was higher among the SCD patients with opioid related admissions. The trends that were noticed during the study period depicts that there existed a low yet stable rate of opioid related hospitalization among the SCD patients, in spite of the frequent prescription of opioids in SCD patients for efficient pain management. It was a case of two edges of the same sword because, on one hand, opioids are necessary for good pain control in this vulnerable population. On the other hand, the rate of opioid overdose deaths in the general population of the United States is rising (as per CDC), this could shape physician prescription practices. This could result in a situation where access to opioids for SCD patients becomes even more restricted and could hinder adequate pain management for those who need it.