Abstract
Public Health, Policy and Ethics
Ruchika Goel, MD, MPH, CABP (she/her/hers)
Senior Medical Director, Corporate Medical Affairs. Professor of Internal Medicine and Pediatrics
Vitalant and Johns Hopkins University
Scottsdale, Arizona, United States
Disclosure(s): No financial relationships to disclose
Sickle cell disease (SCD) is a chronic and debilitating inherited blood disorder and patients with SCD require significant blood transfusion support. While advances in the management of SCD have improved outcomes, re-admission rates among patients remain a significant concern. This study uses a nationally representative database to explore the healthcare burden and predictive factors associated with increased re-admission among adults with SCD in the United States (US).
Study
Design/Methods:
Our study utilized the 2016-2020 Nationwide Re-admissions Database (NRD) to analyze 30-day all-cause unplanned readmission rates among adults with SCD. SCD admissions were identified using ICD-10-CM codes (D57.0, D57.1, D57.2, D57.4, D57.8. The primary outcome was a 30-day all-cause unplanned readmission. Re-admissions were defined as any index admission within 30 days of hospitalization discharge. Mixed-effect Poisson regressions were used to determine independent predictors of readmission among patients with SCD.
Results/Findings:
Between 2016-2020, patients with SCD had a stable overall readmission risk of 33.0%(range 32.6-34.3%), which was significantly higher than the average 12.1% (range 12.0-12.2%) observed in the non-SCD group (p < 0.001).
The first recorded index admission for SCD identified 39,731 unique patients (59% female, 38.9% 18-29yrs, 70.3% had minor/moderate severity of illness; 48.3% resided in lower-income zip code areas, and 68.9% had Medicaid/Medicare coverage). Most SCD admissions occurred in large, teaching hospitals in major metropolitan areas. In the multivariate model, 18-29yr age had marginally increased readmission rates than 30-59yr age. Highest household income had lower readmission than those from lowest income zip codes (aRR=0.92(0.86-0.98). As compared to private insurance, higher readmission risks were seen for Medicare (aRR=1.48(1.40-1.57)) and Medicaid (aRR=1.44(1.35-1.53)). Metropolitan hospitals had higher readmission than non-metropolitan (aRR=1.19(1.07-1.34)). A reduced readmission risk was seen with simple red blood cell (RBC) (aRR=0.88(0.85-0.91)) and exchange transfusions (aRR=0.74(0.58-0.94)). Vaso-occlusive crises were associated were higher readmissions (aRR=(1.36(1.30-1.42)(Figure A)
Conclusions:
Sickle cell disease re-admissions impose a significant burden on the healthcare system in the US and has amongst the highest re-admission rates in chronic conditions. This nationally representative data identifies age, household income, insurance status, hospital location and interventions including RBC transfusion and exchange transfusion as significant independent predictors of hospital re-admission in SCD patients.
By understanding the factors contributing to readmission rates and the associated costs, healthcare stakeholders can develop interventions and policies aimed at reducing re-admissions, improving patient outcomes, and optimizing resource allocation.