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Attell BK, Plaxco AP, Zhou M, Valle J, Reeves SL, Patel PN, Latta K, Smeltzer MP, Snyder AB. Emergency department utilization before and during the COVID-19 pandemic among individuals with sickle cell disease. BMC Emerg Med 2024; 24:134. [PMID: 39075379 PMCID: PMC11287848 DOI: 10.1186/s12873-024-01043-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/08/2024] [Indexed: 07/31/2024] Open
Abstract
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.
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Affiliation(s)
- Brandon K Attell
- Georgia Health Policy Center, Georgia State University, 55 Park Place NE, Atlanta, GA, 30303, USA.
| | - Allison P Plaxco
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, 222 Robison Hall, Memphis, TN, 38152, USA
| | - Mei Zhou
- Georgia Health Policy Center, Georgia State University, 55 Park Place NE, Atlanta, GA, 30303, USA
| | - Jhaqueline Valle
- Tracking California Program, Public Health Institute, 555 12th Street, Suite 600, Oakland, CA, 94607, USA
| | - Sarah L Reeves
- Susan B. Meister Child Health Evaluation and Research Center, Medical School, Department of Pediatrics, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
- Department of Epidemiology, School of Public Health, University of Michigan, 1415, Washington Heights, Ann Arbor, MI, 48109, USA
| | - Pooja N Patel
- Susan B. Meister Child Health Evaluation and Research Center, Medical School, Department of Pediatrics, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Krista Latta
- Susan B. Meister Child Health Evaluation and Research Center, Medical School, Department of Pediatrics, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, 222 Robison Hall, Memphis, TN, 38152, USA
| | - Angela B Snyder
- Georgia Health Policy Center, Georgia State University, 55 Park Place NE, Atlanta, GA, 30303, USA
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Dain AS, Diorio C, Fisher BT, Hankins JS, Witmer CM, Boustany M, Burton M, Ferrolino J, Sadaf S, Ross HS, Maron G. Description of a national, multi-center registry of patients with sickle cell disease and SARS-CoV-2 infection: Data from the Pediatric COVID-19 United States Registry. Pediatr Blood Cancer 2024; 71:e30909. [PMID: 38469996 PMCID: PMC11039375 DOI: 10.1002/pbc.30909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/05/2024] [Accepted: 01/26/2024] [Indexed: 03/13/2024]
Abstract
Children with sickle cell disease (SCD) are at risk of complications from viral infections, including SARS-CoV-2. We present the clinical characteristics and outcomes of pediatric patients with SCD from the Pediatric COVID-19 United States Registry who developed acute COVID-19 due to SARS-CoV-2 infection (n = 259) or multisystem inflammatory syndrome in children (MIS-C; n = 4). Nearly half of hospitalized children with SCD and SARS-CoV-2 infection required supplemental oxygen, though children with SCD had fewer intensive care (ICU) admissions compared to the general pediatric and immunocompromised populations. All registry patients with both SCD and MIS-C required ICU admission. Children with SCD are at risk of severe disease with SARS-CoV-2 infection, highlighting the importance of vaccination in this vulnerable population.
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Affiliation(s)
- Aleksandra S Dain
- Division of Hematology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Caroline Diorio
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brian T Fisher
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jane S Hankins
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Pennsylvania, USA
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Pennsylvania, USA
| | - Char M Witmer
- Division of Hematology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mickael Boustany
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Madeline Burton
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Pennsylvania, USA
| | - Jose Ferrolino
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Pennsylvania, USA
| | - Salma Sadaf
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hailey S Ross
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Pennsylvania, USA
| | - Gabriela Maron
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Pennsylvania, USA
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Peng HK, Dombkowski KJ, Plegue MA, Latta K, Malosh R, Creary MS, Reeves SL. COVID-19 Immunization Coverage Among People With Sickle Cell Disease. JAMA Netw Open 2024; 7:e2351618. [PMID: 38190186 PMCID: PMC10774988 DOI: 10.1001/jamanetworkopen.2023.51618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/21/2023] [Indexed: 01/09/2024] Open
Abstract
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.
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Affiliation(s)
- Hannah K. Peng
- Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor
| | - Kevin J. Dombkowski
- Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor
| | - Melissa A. Plegue
- Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor
| | - Krista Latta
- Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor
| | - Ryan Malosh
- Michigan Department of Health and Human Services, Lansing
| | | | - Sarah L. Reeves
- Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor
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Michelon I, Vilbert M, Pinheiro IS, Costa IL, Lorea CF, Castonguay M, Tran TH, Forté S. COVID-19 outcomes in patients with sickle cell disease and sickle cell trait compared with individuals without sickle cell disease or trait: a systematic review and meta-analysis. EClinicalMedicine 2023; 66:102330. [PMID: 38162948 PMCID: PMC10755716 DOI: 10.1016/j.eclinm.2023.102330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 01/03/2024] Open
Abstract
Background Clinical manifestations and severity of SARS-CoV-2 infection in individuals with sickle cell disease (SCD) and sickle cell trait (SCT) are not well understood yet. Methods We performed a systematic review and meta-analysis to assess COVID-19 outcomes in individuals with SCD or SCT compared to individuals without sickle cell disease or trait. An electronic search on PubMed, Embase, and Cochrane Library was performed on August 3, 2023. Two authors (IFM and ISP) independently screened (IFM and ISP) and extracted data (IFM and ILC) from included studies. Main exclusion criterion was the absence of the non-SCD/SCT group. Exposure effects for binary endpoints were compared using pooled odds ratio (OR) with 95% confidence intervals (CI). I2 statistics was used to assess the heterogeneity and DerSimonian and Laird random-effects models were applied for all analyses to minimize the impact of differences in methods and outcomes definitions between studies. The overall quality of evidence was assessed using the GRADE system. Review Manager 5.4 and R software (v4.2.2) were used for statistical analyses. Registered with PROSPERO, CRD42022366015. Findings Overall, 22 studies were included, with a total of 1892 individuals with SCD, 8677 individuals with SCT, and 1,653,369 individuals without SCD/SCT. No difference in all-cause mortality was seen between SCD/SCT and non-SCD/SCT (OR 1.18; 95% CI 0.78-1.77; p = 0.429; I2 = 82%). When considering only studies adjusted for confounders (8 studies), patients with SCD/SCT were shown to be at increased risk of death (OR 1.86; 95% CI 1.30-2.66; p = 0.0007; I2 = 34%). No significant difference was seen between individuals with SCD and SCT (p = 0.863). The adjusted for confounders analysis for hospitalisation revealed higher rates for the SCD (OR 5.44; 95% CI 1.55-19.13; p = 0.008; I2 = 97%) and the SCT groups (OR 1.31; 95% CI 1.10-1.55; p = 0.002; I2 = 0) compared to the non-SCD/SCT population. Moreover, it was significantly higher for the SCD group (test for subgroup difference; p = 0.028). Interpretation Our findings suggest that patients with SCD or SCT may present with a higher mortality and hospitalisation rates due to COVID-19 infection. Funding None.
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Affiliation(s)
- Isabella Michelon
- Department of Medicine, School of Medicine, Catholic University of Pelotas, Pelotas, Brazil
| | - Maysa Vilbert
- Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Isabela Lino Costa
- Department of Medicine, School of Medicine, Federal University of Mineiro Triangle, Uberaba, Brazil
| | | | - Mathias Castonguay
- Department of Medicine, Centre Hospitalier de l’Université de Montréal, Quebec, Canada
| | - Thai Hoa Tran
- Division of Paediatric Hematology and Oncology, Department of Pediatrics, Centre Hospitalier Universitaire de Sainte-Justine, Montréal, Quebec, Canada
| | - Stéphanie Forté
- Division of Hematology and Medical Oncology, Departement of Medicine, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Carrefour de l'Innovation, Centre de Recherche du CHUM (CRCHUM), Montréal, Canada
- Division of Hematology and Medical Oncology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
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Liang T, Guo K, Ni P, Duan G, Zhang R. The association of sickle cell disorder with adverse outcomes in COVID-19 patients: A meta-analysis. J Med Virol 2023; 95:e29120. [PMID: 37772453 DOI: 10.1002/jmv.29120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023]
Abstract
The aim is to elucidate the relationship between sickle cell disorder and severe COVID-19. We systematically searched the required articles in three electronic databases, extracting and pooling effect sizes (ES) and 95% confidence interval (CI) from each eligible study to evaluate the effect of combined sickle cell disorder on adverse consequences in patients with COVID-19. This meta-analysis included 21 studies. Sickle cell disease (SCD) was a risk factor for mortality (pooled ES = 1.70, 95% CI: 1.00-2.92, p = 0.001), hospitalization (pooled ES = 6.21, 95% CI: 3.60-10.70, p = 0.000) and intensive care unit (ICU) admission (pooled ES = 2.29, 95% CI: 1.61-3.24, p = 0.099) in COVID-19 patients. Patients with SCD had an increased risk of respiratory failure/mechanical ventilation, but a statistical association was not found (pooled ES = 1.21, 95%CI: 0.74-1.98, p = 0.036). There was significant heterogeneity between SCD and death, hospitalization, and respiratory failure/mechanical ventilation. The results of meta-regression of SCD and hospitalization suggested that the tested variables including Area (p = 0.642), study design (p = 0.739), sample size (p = 0.397), proportion of males (p = 0.708), effect type (p = 0.723), whether confounding factors are adjusted (p = 0.606) might not be the source of heterogeneity. In addition, sickle cell trait (SCT) was significantly associated with the mortality (pooled ES = 1.54, 95% CI: 1.28-1.85, p = 0.771) and hospitalization (pooled ES = 1.20, 95% CI: 1.07-1.35,p = 0.519) in patients with COVID-19. But any increased risk of ICU admission/severe (pooled ES = 1.24, 95% CI: 0.95-1.62, p = 0.520) and mechanical ventilation (OR = 1.00, 95%CI:0.59-1.69) in COVID-19 patients with SCT was not observed. Sensitivity analysis demonstrated that the results were robust. The results of the funnel plot and Egger's test did not support the existence of publication bias. Current meta-analysis indicated that sickle cell disorder has a meaningful impact on COVID-19 progression to severe cases and associated deaths. However, further investigations and research to validate the current findings is indispensable.
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Affiliation(s)
- Tianyi Liang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Kaixin Guo
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Peng Ni
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Rongguang Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
- International School of Public Health and One Health and The First Affiliated Hospital, Hainan Medical University, Haikou, China
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