OBJECTIVES: Patients with sickle cell disease (SCD) experience several severe and life-threatening complications across their lifespans. Thus, information on the clinical course of the disease is essential in developing interventions to improve the care of these patients. This study aims to investigate the number, type, and duration of SCD-related complications by age group among pediatric, adolescent, and young adult patients with SCD in Texas Medicaid.

METHODS: 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 an 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.

RESULTS: Of the 3,606 patients (mean age=13.8 [±7.4]) included, 66.5% were female and 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, type, and duration of complications differed significantly (all p<0.0001) by age group. Patients aged 10-14 years had the highest mean number of encounters for complications, organ-systems affected, and chronic complications, while those aged 22-26 years had the lowest mean number of encounters for complications. Patients aged 5-9 years had a 23% significantly lower likelihood of experiencing vaso-occlusive crises, respiratory infections, chronic anemia, or acute chest syndrome, compared to those aged 2-4 years (Odds Ratio [OR]=0.774, 95% CI=0.604-0.993, p=0.0441), while controlling for other covariates.

CONCLUSIONS: Patterns of complications in children, adolescents, and young adults with SCD differ significantly by age group, especially for those aged 10-14 years and 22-26 years. Better access to health care beyond the transition period and the recommended use of preventive therapy are needed to improve the health outcomes of this population.