title: Medical care utilization and mortality in sickle cell disease: a population-based study.
abstract: The purpose of this study was to evaluate the pattern of medical care utilization and mortality in children and adults with sickle cell disease (SCD) in the state of Tennessee. Rates of hospitalization, emergency department visits, and deaths were measured in a cohort of adults and children with SCD enrolled in TennCare, Tennessee's Medicaid managed health care program, from January 1995 to December 2002. TennCare data linked to Tennessee vital records were used to define the population and identify the outcomes. For children less than 5 years of age, the mortality rate was similar to that of other black Tennessee children (P = 0.71). Among children, the death rate was highest in 10-19 years of age and was 8-fold higher than Tennessee's race- and age-specific rate. Among 20- to 49-year-old patients with SCD, mortality was significantly higher in males than in females (P < 0.001). As compared to the black population without SCD in TennCare, patients with SCD had 7-30 times higher rate of hospitalization and 2-6 times higher rates of emergency department visits (P < 0.001). The death rate in adolescents and young adults with SCD continues to be much higher than population-specific rates. Interventions to prevent morbidity and mortality related to SCD are urgently needed.
authors.affiliation: Division of Pediatric Hematology/Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-6310, USA. sadhna.shankar@vanderbilt.edu
authors.forename: Sadhna M
authors.initials: SM
authors.lastname: Shankar
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Arbogast
authors.forename: Ed
authors.initials: E
authors.lastname: Mitchel
authors.forename: William O
authors.initials: WO
authors.lastname: Cooper
authors.forename: Winfred C
authors.initials: WC
authors.lastname: Wang
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000755:Anemia, Sickle Cell / Q000401:mortality*; D044383:Black People; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D013221:State Health Plans; D013714:Tennessee; D014481:United States; D001741:Black or African American