RESUMO
Sickle cell disease (SCD) remains a public health priority in the United States because of its association with complex health needs, reduced life expectancy, lifelong disabilities, and high cost of care. A cross-sectional analysis was conducted to calculate the crude and race-specific birth prevalence for SCD using state newborn screening program records during 2016-2020 from 11 Sickle Cell Data Collection program states. The percentage distribution of birth mother residence within Social Vulnerability Index quartiles was derived. Among 3,305 newborns with confirmed SCD (including 57% with homozygous hemoglobin S or sickle ß-null thalassemia across 11 states, 90% of whom were Black or African American [Black], and 4% of whom were Hispanic or Latino), the crude SCD birth prevalence was 4.83 per 10,000 (one in every 2,070) live births and 28.54 per 10,000 (one in every 350) non-Hispanic Black newborns. Approximately two thirds (67%) of mothers of newborns with SCD lived in counties with high or very high levels of social vulnerability; most mothers lived in counties with high or very high levels of vulnerability for racial and ethnic minority status (89%) and housing type and transportation (64%) themes. These findings can guide public health, health care systems, and community program planning and implementation that address social determinants of health for infants with SCD. Implementation of tailored interventions, including increasing access to transportation, improving housing, and advancing equity in high vulnerability areas, could facilitate care and improve health outcomes for children with SCD.
Assuntos
Anemia Falciforme , Etnicidade , Feminino , Criança , Humanos , Recém-Nascido , Estados Unidos/epidemiologia , Prevalência , Estudos Transversais , Vulnerabilidade Social , Grupos Minoritários , Anemia Falciforme/epidemiologia , Anemia Falciforme/diagnósticoRESUMO
People with sickle cell disease (SCD) often have emergency department (ED) revisits. The characteristics of people with SCD with ED revisits were assessed in this study using Medicaid administrative claims data from California and Georgia, representing 2794 and 3641 individuals with SCD, respectively. In both states, those with 6+ primary care provider (PCP) encounters had the highest percentage of ED revisits. In California, those with 6+ hematology encounters had the lowest percentage of individuals with an ED revisit; in Georgia, those with 1-2 hematology encounters. Increasing access to hematologic care may reduce ED revisits among people with SCD.
Assuntos
Anemia Falciforme , Serviço Hospitalar de Emergência , Humanos , Anemia Falciforme/terapia , Anemia Falciforme/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Masculino , Feminino , Adolescente , Criança , Adulto , Pré-Escolar , Adulto Jovem , Georgia/epidemiologia , Lactente , California/epidemiologia , Estados Unidos/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Pessoa de Meia-Idade , Recém-NascidoRESUMO
BACKGROUND AND OBJECTIVE: National guidelines recommend that children with sickle cell anemia (SCA) be seen regularly by primary care providers (PCPs) as well as hematologists to receive comprehensive, multidisciplinary care. The objective is to characterize the patterns of primary and hematology care for children with SCA in Michigan. METHODS: Using validated claims definitions, children ages 1-17 years with SCA were identified using Michigan Medicaid administrative claims from 2010 to 2018. We calculated the number of outpatient PCP and hematologist visits per person-year, as well as the proportion of children with at least one visit to a PCP, hematologist, or both a PCP and hematologist annually. Negative binomial regression was used to calculate annual rates of visits for each provider type. RESULTS: A total of 875 children contributed 2889 person-years. Of the total 22,570 outpatient visits, 52% were with a PCP and 34% with a hematologist. Annually, 87%-93% of children had a visit with a PCP, and 63%-85% had a visit with a hematologist. Approximately 66% of total person-years had both visit types within a year. The annual rate ranged from 2.3 to 2.5 for hematologist visits and from 3.7 to 4.1 for PCP visits. CONCLUSIONS: Substantial gaps exist in the receipt of annual hematology care. Given that the majority of children with SCA see a PCP annually, strategies to leverage primary care visits experienced by this population may be needed to increase receipt of SCA-specific services.
Assuntos
Anemia Falciforme , Atenção Primária à Saúde , Humanos , Anemia Falciforme/terapia , Criança , Masculino , Pré-Escolar , Feminino , Adolescente , Lactente , Atenção Primária à Saúde/estatística & dados numéricos , Estados Unidos , Michigan , Hematologia , Seguimentos , Medicaid/estatística & dados numéricos , PrognósticoRESUMO
This study examined associations between emergency department (ED) visits and social vulnerability index (SVI) among Michigan's population with sickle cell disease (SCD) using data from the Michigan Sickle Cell Data Collection program (n = 3658 in 2018). SVI was higher among census tracts where people with SCD resided (mean SVI = 0.67; SD = 0.27) compared to census tracts without SCD residents (mean SVI = 0.39; SD = 0.25; p < .001). For children with SCD, for every 0.1 increase in SVI score, the number of ED visits increased by 6% (IRR = 1.061; SE = 0.03; p = .038). Future research should investigate the association between SVI and ED use, at the community and household levels, to elucidate strategies to reduce ED use among children with SCD.
Assuntos
Anemia Falciforme , Serviço Hospitalar de Emergência , Vulnerabilidade Social , Humanos , Anemia Falciforme/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Masculino , Feminino , Michigan/epidemiologia , Adolescente , Criança , Pré-Escolar , Adulto , Adulto Jovem , Lactente , Seguimentos , Pessoa de Meia-Idade , PrognósticoRESUMO
BACKGROUND: The emergency department (ED) is a vital source of healthcare for individuals living with sickle cell disease (SCD). Prior research indicates that during the COVID-19 pandemic some individuals with SCD avoided the ED for fear of acquiring COVID-19 or delayed visiting the ED by self-management of symptoms or pain crisis at home. The purpose of the current study was to understand ED utilization rates before and during the pandemic among individuals living with SCD. METHODS: We conducted a retrospective cohort study using population-based SCD surveillance systems in California, Georgia, Michigan, and Tennessee to assess the impact of the pandemic on ED utilization among people with SCD by (1) analyzing trends in monthly ED utilization from January 2019 - December 2020, with specific attention given to immediate changes at the onset of the pandemic; and (2) calculating changes in the volume of utilization by comparing the total ED visits made from March - December 2020 to the same period in 2019, both overall and by demographic characteristics. RESULTS: Across all states, a decline in ED utilization during the onset of the pandemic was seen, with the largest decline seen in those under age 10. By December 2020, utilization rates were higher than their lowest observed month of April 2020, but had not fully returned to pre-COVID levels. During the pandemic, ED visits in each state decreased by as much as 25%, and the number of people with any ED utilization decreased by as much as 26%. CONCLUSIONS: This study confirms and extends the existing literature related to the impact of the pandemic on healthcare utilization patterns in the US, in a unique population with increased healthcare needs.
Assuntos
Anemia Falciforme , COVID-19 , Serviço Hospitalar de Emergência , Humanos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Anemia Falciforme/epidemiologia , Anemia Falciforme/terapia , COVID-19/epidemiologia , Estudos Retrospectivos , Feminino , Masculino , Adulto , Adolescente , Criança , Pessoa de Meia-Idade , Adulto Jovem , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , SARS-CoV-2 , Estados Unidos/epidemiologia , Pré-EscolarRESUMO
Background: Telehealth can be defined as using remote technologies to provide health care. It may increase access to care among people with sickle cell disease (SCD). This study examined (1) telehealth use, (2) characteristics of telehealth use, and (3) differences between telehealth users and nonusers among people with SCD during the COVID-19 pandemic. Methods: This was a retrospective analysis of Medicaid claims among four states [California (CA), Georgia (GA), Michigan (MI), Tennessee (TN)] participating in the Sickle Cell Data Collection program. Study participants were individuals ≥1 year old with SCD enrolled in Medicaid September 2019-December 2020. Telehealth encounters during the pandemic were characterized by provider specialty. Health care utilization was compared between those who did (users) and did not (nonusers) use telehealth, stratified by before and during the pandemic. Results: A total of 8,681 individuals with SCD (1,638 CA; 3,612 GA; 1,880 MI; and 1,551 TN) were included. The proportion of individuals with SCD that accessed telehealth during the pandemic varied across states from 29% in TN to 80% in CA. During the pandemic, there was a total of 21,632 telehealth encounters across 3,647 users. In two states (MI and GA), over a third of telehealth encounters were with behavioral health providers. Telehealth users had a higher average number of health care encounters during the pandemic: emergency department (pooled mean = 2.6 for users vs. 1.5 for nonusers), inpatient (1.2 for users vs. 0.6 for nonusers), and outpatient encounters (6.0 for users vs. 3.3 for nonusers). Conclusions: Telehealth was frequently used at the beginning of the COVID-19 pandemic by people with SCD. Future research should focus on the context, facilitators, and barriers of its implementation in this population.
Assuntos
Anemia Falciforme , COVID-19 , Medicaid , SARS-CoV-2 , Telemedicina , Humanos , COVID-19/epidemiologia , Telemedicina/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Anemia Falciforme/terapia , Anemia Falciforme/epidemiologia , Estados Unidos/epidemiologia , Feminino , Masculino , Adulto , Estudos Retrospectivos , Adolescente , Pessoa de Meia-Idade , Adulto Jovem , Criança , Pandemias , Pré-Escolar , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , LactenteRESUMO
This cross-sectional study compares the completion of the primary COVID-19 vaccine series in Michigan residents with vs without sickle cell disease and by age group.
Assuntos
Anemia Falciforme , COVID-19 , Humanos , Cobertura Vacinal , COVID-19/prevenção & controleRESUMO
This cohort study examines patterns of Medicaid coverage in the first 3 years of life among children with sickle cell disease across 5 states.