Clinical outcomes and healthcare utilization in patients with sickle cell disease: a nationwide cohort study of Medicaid beneficiaries
| Autor: | Rishi J. Desai, Mufaddal Mahesri, Denise Globe, Alex Mutebi, Rhonda Bohn, Maureen Achebe, Raisa Levin, Sebastian Schneeweiss |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Disease Anemia Sickle Cell 03 medical and health sciences 0302 clinical medicine Risk Factors Epidemiology medicine Risk of mortality Humans Mortality Child business.industry Proportional hazards model Medicaid Hazard ratio Age Factors Infant Hematology General Medicine Middle Aged Patient Acceptance of Health Care Confidence interval United States 030220 oncology & carcinogenesis Child Preschool Emergency medicine Female business 030215 immunology Cohort study Follow-Up Studies |
| Zdroj: | Annals of hematology. 99(11) |
| ISSN: | 1432-0584 |
| Popis: | To add to the limited existing evidence on clinical outcomes and healthcare use in sickle cell disease (SCD) among beneficiaries of the US Medicaid program, we conducted a cohort study using nationwide Medicaid claims data (2000–2013). Patients were included based on HbSS SCD diagnosis and followed until Medicaid disenrollment, death, bone marrow transplant, or end of data availability to assess vasoocclusive crises (VOC), emergency room (ER) visits, hospitalizations, outpatient visits, and blood transfusions. Annualized event rates (with 95% confidence intervals [CI]) were reported. The impact of VOCs on the risk of mortality was analyzed using a multivariable Cox model with VOC modeled as time-varying and updated annually. In a total of 44,033 SCD patients included with a mean (SD) age of 15.7 (13.6) years, the VOC rate (95% CI) was 3.71 (3.70–3.72) per person-year, with highest rate among patients 19–35 years who had ≥ 5 VOCs at baseline (13.20 [13.15–13.26]). Event rates (95% CI) per person per year for other outcomes were 2.97 (2.97–2.98) ER visits, 2.39 (2.38–2.40) hospitalizations, 5.80 (5.79–5.81) outpatient visits, and 0.91 (0.90–0.91) blood transfusions. A higher VOC burden in the preceding year was associated with an increased risk of mortality, with a hazard ratio (95% CI) of 1.26 (1.14–1.40) for 2–4 VOC vs. |
| Databáze: | OpenAIRE |
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