title: National trends in hospitalizations for sickle cell disease in the United States following the FDA approval of hydroxyurea, 1998-2008.
abstract: BACKGROUND
  Patients with sickle cell disease (SCD) can suffer frequent hospital admissions for painful vasoocclusive crises. Hydroxyurea was approved by the FDA in 1998 to decrease the morbidity of SCD, but nationwide hospitalizations for SCD in the United States since 1998 have not been evaluated. We hypothesized that the availability of hydroxyurea for SCD would be associated with a decrease in hospitalizations for SCD over time.
  
  
  OBJECTIVE
  To assess trends in hospitalization and length-of-stay in hospital for SCD in the United States, 1998 through 2008.
  
  
  METHODS
  Retrospective cohort study of SCD-related hospital discharges in the Nationwide Inpatient Sample of US hospital discharges.
  
  
  METHODS
  All discharges in the Nationwide Inpatient Sample associated with a principal diagnosis of SCD in blacks, 1998 through 2008.
  
  
  METHODS
  Trends in hospitalization rates and average length-of-stay in hospital for SCD.
  
  
  RESULTS
  We found 216 (95% confidence interval, 173.3-258.7) SCD-related hospitalizations per 100,000 US blacks in 1998 and 178.4 (95% confidence interval, 144.2-212.5) in 2008, but no consistent yearly decrease, 1998 through 2008 (P=0.30). Conversely, the length-of-stay in hospital in 1998 was 5.38 days and in 2008 was 5.18 days, an absolute change of 0.2 days and a downward trend that was statistically significant.
  
  
  CONCLUSIONS
  Between 1998 and 2008, there was not a steady decrease in hospitalization rates for the population of SCD in the United States. On the contrary, there was a decline in length-of-stay in hospital over this time. Hydroxyurea underuse is well documented. Efforts to increase hydroxyurea use may help to reduce hospitalization rates.
authors.affiliation: *Department of Medicine, Division of Hematology †Department of Medicine, Division of General Medicine and Primary Care, Brigham and Women's Hospital ‡Department of Health Care Policy, Harvard Medical School, Boston, MA §Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Okam
authors.forename: Shimon
authors.initials: S
authors.lastname: Shaykevich
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Ebert
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D000755:Anemia, Sickle Cell / Q000188:drug therapy*; D000986:Antisickling Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017277:Drug Approval; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014486:United States Food and Drug Administration; D055815:Young Adult
chemical_list: D000986:Antisickling Agents; D006918:Hydroxyurea