Association between Employment Status and Hospitalization of Patients with Sickle Cell Disease: A Retrospective, Observational Pilot Study
Authors: Idowu Modupe , Chung Tong Han , Yu Katherine 
Published: October 2019

Abstract
Introduction: Sickle cell disease (SCD) has a negative impact on job functioning and majority of SCD patients cannot retain their jobs. Recurrent acute vaso-occlusive crises (VOC) and organ dysfunction related to SCD can limit employment options and interfere with job retention. Potential associates of unemployment and poor job performance in adults with SCD include health-related (pain frequency and intensity, health-care utilization) and psychosocial (support system, coping mechanism). Unemployment can lead to major psychosocial stress that may translate into physiologic stress resulting in increased emergency department (ED) visits and hospitalizations. Poor psychosocial state may predispose patients to increased chronic pain, and use of alcohol or illicit drugs. The aim of this study is to identify the association between the status of employment of SCD and SCD pain-related hospitalizations.
Patients and Methods: This was a retrospective, observational pilot study of SCD patients at our comprehensive SCD clinic. Surveys were administered during routine clinic visits. Surveys contain multiple questions relating to patients' employment history and healthcare utilization. We excluded patients on chronic transfusion therapy and those with disabling conditions unrelated to SCD. We reviewed extensive data in our electronic medical records relating to subjects of interest. Among the patients who have at least 12 months of continuous employment status (employed or unemployed), we assessed SCD pain-related hospitalization rates in the previous 12 months period. Descriptive analysis was performed with frequency distributions. Univariate logistic regression was conducted to investigate the association between employment status and hospitalization rate.
Results: A cohort of 74 SCD patients completed surveys about employment and hospitalization history. Of the patients, 51 patients showed continuous employment history greater than 12 months. Thirty-nine out of fifty-one (76.47%) were unemployed. Majority of patients (90.20%) were hospitalized at least once and sixteen patients (31.37%) were hospitalized more than 5 times during the previous 12 months. The univariate logistic regression analysis showed SCD patients with employed status were significantly less likely to be admitted to the hospital compared with unemployed SCD patients (Odds Ratio 0.255, 95% CI: 0.073-0.895).
Conclusions: In this cohort, unemployed SCD patients have a significantly higher rate of hospitalization for pain crisis when compared with employed SCD patients. Development of interventions and programs that can improve job accommodation for SCD patients will likely decrease hospitalization and reduce related healthcare costs. In addition, the negative economic impact of SCD on the society will be less. Moreover, improved job accommodation will likely lead to better psychosocial and overall well-being for the patients. Providers who care for SCD patients should encourage patients to engage in job activities as tolerated which may positively influence their overall health.

Disclosures
No relevant conflicts of interest to declare.