Examination of age-related medical complications among pediatric, adolescent, and young adult patients with sickle cell disease in Texas Medicaid

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2023-08

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Patients with sickle cell disease (SCD) experience complications of varying types and severity across their lifespans, beginning as early as six months of age. Because of the variability and complexity of the manifestations of SCD, information on the clinical course of the disease is important in designing programs to improve the care of patients with SCD. The study purpose is to investigate the number, type, and duration of SCD-related complications by age group among pediatric, adolescent, and young adult SCD patients in Texas Medicaid. Texas Medicaid prescription and medical claims from 03/01/2012 to 05/31/2021 were retrospectively analyzed. Subjects were included if they were aged 2-26 years, had ≥ 3 hospitalizations or outpatient visits associated with a SCD diagnosis, and were continuously enrolled in Texas Medicaid for ≥ 12 months after the index date. Descriptive and inferential (ANOVA, Chi-square, and logistic regression) statistics were used to address the study objectives. The primary outcomes were the number, type (organ-system involvement), and duration of complications (acute and chronic, separately), and having at least one of the most salient complications. Of the 3,606 patients (mean age = 13.8 [±7.4]) included, subjects were categorized into six age groups: 2-4 (15.3%), 5-9 (18.4%), 10-14 (16.5%), 15-18 (15.8%), 19-21 (13.5%), and 22-26 (20.6%) years. Overall, the number (p<0.0001), type (p<0.0001), and duration (p<0.0001) of complications differed significantly by age group. Generally, patients aged 10-14 years appeared to have the highest mean number of complications, organ-systems affected, and chronic complications, while those aged 22-26 years had the lowest mean number of these complications. Patients aged 5-9 years had 23% significantly lower odds of experiencing at least one of the most salient complications, compared to those aged 2-4 years (OR=0.774, 95% CI=0.604-0.993, p=0.0441), while controlling for other covariates. Trends in the occurrence of complications in children, adolescents, and young adults with SCD differ significantly by age group, particularly for those aged 10-14 years, and 22-26 years. Encouraged use of preventive therapy (for those aged 10-14 years) and enhanced access to health care beyond the transition age (for those aged 22-26 years) are needed to improve the health outcomes of this population.

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