J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website http://www.thejh.org

Original Article

Volume 8, Number 1, March 2019, pages 11-16

Trends in Hospitalizations for Sickle Cell Disease Related-Complications in USA 2004 - 2012

Figure 1. Monthly incidence of hospitalizations for SCD complications, per 100,000 African-American population. SCD: sickle cell disease.

Figure 2. Seasonal deviation in monthly hospitalization rates, per 100,000 AA population. AA: African-American.

**Table 1.** Annual Hospitalization Rates, Demographics, Hospital-Level Characteristics, Mortality, LOS and Charges
	2004	2005	2006	2007	2008	2009	2010	2011	2012
P < 0.001 by Chi-squared test; *P < 0.001 by independent samples Kruskal-Wallis test (for skewed distributions).
N admissions, weighted	39,802	45,957	43,916	49,440	48,639	52,181	63,277	57,861	56,635
Black population	37,510,582	37,961,688	38,443,048	38,935,533	39,429,414	39,902,270	40,357,516	40,775,287	41,204,793
Hospitalization rate, per 100,000	106.1	121.1	114.2	127.0	123.4	130.8	156.8	141.9	137.4
Gender*	Male	17,819 (44.8%)	20,991 (45.8%)	18,715 (42.7%)	21,736 (44.0%)	21,669 (44.6%)	23,305 (44.7%)	27,796 (44.0%)	24,057 (41.6%)	24,595 (43.4%)
Female	21,922 (55.2%)	24,857 (54.2%)	25,105 (57.3%)	27,645 (56.0%)	26,885 (55.4%)	28,794 (55.3%)	35,396 (56.0%)	33,743 (58.4%)	32,040 (56.6%)
Median household income quartile*	First	20,831 (53.1%)	20,296 (45.1%)	20,573 (47.9%)	23,467 (49.0%)	24,161 (50.6%)	23,066 (45.7%)	29,583 (48.6%)	26,803 (47.3%)	26,780 (48.4%)
Second	8,907 (22.7%)	10,876 (24.2%)	10,595 (24.7%)	11,028 (23.0%)	10,494 (22.0%)	12,915 (25.6%)	14,466 (23.8%)	12,076 (21.3%)	12,055 (21.8%)
Third	5,395 (13.8%)	8,281 (18.4%)	7,434 (17.3%)	7,896 (16.5%)	8,054 (16.9%)	8,175 (16.2%)	10,274 (16.9%)	11,420 (20.1%)	9,830 (17.8%)
Fourth	4,071 (10.4%)	5,501 (12.2%)	4,314 (10.1%)	5,464 (11.4%)	5,034 (10.5%)	6,319 (12.5%)	6,541 (10.7%)	6,402 (11.3%)	6,690 (12.1%)
In-hospital mortality, N (%)†	409 (1.03%)	401 (0.87%)	459 (1.05%)	473 (0.96%)	440 (0.90%)	490 (0.94%)	534 (0.84%)	494 (0.85%)	575 (1.02%)
Primary payer*	Medicare	10,028 (25.3%)	10,966 (23.9%)	11,812 (26.9%)	13,407 (27.2%)	13,283 (27.4%)	15,183 (29.2%)	17,078 (27.1%)	18,729 (32.4%)	17,500 (31.0%)
Medicaid	20,151 (50.9%)	22,720 (49.5%)	20,648 (47.0%)	22,116 (44.8%)	20,070 (47.5%)	24,029 (46.1%)	29,722 (27.1%)	25,298 (43.8%)	25,910 (45.8%)
Private	7,073 (17.9%)	9,045 (19.7%)	8,670 (19.8%)	9,204 (18.7%)	9,046 (18.6%)	8,790 (16.9%)	12,065 (19.1%)	10,420 (18.0%)	9,390 (16.6%)
Self-pay	1,290 (3.3%)	1,587 (3.5%)	1309 (3.0%)	2,231 (4.5%)	1,894 (3.9%)	2,559 (4.9%)	2,498 (4.0%)	1,916 (3.3%)	2,045 (3.6%)
No charge	163 (0.4%)	208 (0.5%)	31 (0.1%)	406 (0.8%)	202 (0.4%)	207 (0.4%)	223 (0.4%)	136 (0.2%)	165 (0.3%)
Admission type*	Emergency	28,159 (75.3%)	31,167 (72.8%)	31,285 (76.6%)	36,117 (76.7%)	35,150 (78.4%)	35,852 (74.5%)	45,337 (75.6%)	41,226 (76.4%)	N/A
Urgent	5,665 (15.1%)	6,404 (15.0%)	5,944 (14.6%)	6,535 (13.9%)	5,566 (12.4%)	8,812 (18.3%)	9,008 (15.0%)	8,388 (15.6%)
Elective	3,558 (9.5%)	4,803 (11.2%)	3,601 (8.8%)	4,405 (9.4%)	4,108 (9.2%)	3,433 (7.1%)	5,592 (9.3%)	4,276 (7.9%)
Location & teaching status of hospital*	Rural	1,929 (4.8%)	2,858 (6.2%)	2,470 (5.6%)	3,071 (6.2%)	2,744 (5.6%)	2,483 (4.9%)	3,219 (5.2%)	4,085 (7.2%)	2,475 (4.4%)
Urban nonteach.	11,704 (29.4%)	12,390 (27.0%)	12,068 (27.5%)	14,693 (29.8%)	14,396 (29.6%)	15,373 (30.6%)	14,431 (23.3%)	16,932 (29.7%)	14,980 (26.5%)
Urban teach.	26,168 (65.7%)	30,709 (66.8%)	29,304 (66.8%)	31,617 (64.0%)	31,499 (64.8%)	32,371 (64.4%)	44,460 (71.6%)	36,087 (63.2%)	39,180 (69.2%)
Region of hospital*	Northeast	8,168 (20.5%)	8,386 (18.2%)	10,878 (24.8%)	7,938 (16.1%)	9,238 (19.0%)	9,676 (18.5%)	12,157 (19.2%)	11,308 (19.5%)	11,165 (19.7%)
Midwest	7,338 (18.4%)	8,859 (19.3%)	7,724 (17.6%)	8,284 (16.8%)	6,396 (13.2%)	11,386 (21.8%)	9,920 (15.7%)	10,114 (17.5%)	10,355 (18.3%)
South	21,398 (53.8%)	24,353 (53.0%)	21,164 (48.2%)	29,550 (59.8%)	27,559 (56.7%)	25,769 (49.4%)	36,709 (58.0%)	31,326 (54.1%)	29,280 (51.7%)
West	2,898 (7.3%)	4,359 (9.5%)	4,150 (9.4%)	3,668 (7.4%)	5,446 (11.2%)	5,350 (10.3%)	4,492 (7.1%)	5,112 (8.8%)	5,835 (10.3%)
Age, years**, mean ± SD, median (IQR)	28.7 ± 14.5, 27 (20 - 38)	27.4 ± 15.1, 26 (17 - 37)	29.68 ± 14.44, 28 (20 - 39)	29.65 ± 14.35, 28 (21 - 39)	29.64 ± 14.50, 28 (21 - 39)	30.30 ± 14.29, 29 (22 - 40)	28.77 ± 14.73, 27 (20 - 37)	31.47 ± 14.21, 30 (22 - 40)	30.34 ± 14.84, 29 (22 - 39)
LOS, days**, mean ± SD, median (IQR)	7.12 ± 7.65, 5 (3 - 9)	7.08 ± 8.24 5 (3 - 8)	7.05 ± 7.94, 5 (3 - 9)	6.97 ± 7.49, 5 (3 - 8)	6.61 ± 6.85, 5 (3 - 8)	6.46 ± 6.25, 5 (3 - 8)	6.40 ± 6.43, 5 (3 - 8)	6.37 ± 7.16, 5 (3 - 8)	6.23 ± 6.42, 5 (3 -8)
Charges, thousand dollars**, mean ± SD, median (IQR)	25.36 ± 37.91, 15.35 (8.99 - 27.57)	27.33 ± 39.83, 16.32 (9.19 - 29.96)	29.86 ± 41.64, 18.15 (10.39 - 34.09)	33.38 ± 49.69, 20.51 (11.66 - 36.88)	30.98 ± 44.57, 19.26 (11.45 - 35.19)	35.32 ± 47.72, 21.95 (12.47 - 39.75)	35.49 ± 50.34, 22.14 (12.80 - 40.48)	39.03 ± 80.02, 23.54 (13.81 - 42.37)	41.32 ± 68.74, 24.78 (14.37 - 45.24)

Table 1. Annual Hospitalization Rates, Demographics, Hospital-Level Characteristics, Mortality, LOS and Charges

2004

2005

2006

2007

2008

2009

2010

2011

2012

*P < 0.001 by Chi-squared test; **P < 0.001 by independent samples Kruskal-Wallis test (for skewed distributions).

N admissions, weighted

39,802

45,957

43,916

49,440

48,639

52,181

63,277

57,861

56,635

Black population

37,510,582

37,961,688

38,443,048

38,935,533

39,429,414

39,902,270

40,357,516

40,775,287

41,204,793

Hospitalization rate, per 100,000

106.1

121.1

114.2

127.0

123.4

130.8

156.8

141.9

137.4

Gender*

Male

17,819 (44.8%)

20,991 (45.8%)

18,715 (42.7%)

21,736 (44.0%)

21,669 (44.6%)

23,305 (44.7%)

27,796 (44.0%)

24,057 (41.6%)

24,595 (43.4%)

Female

21,922 (55.2%)

24,857 (54.2%)

25,105 (57.3%)

27,645 (56.0%)

26,885 (55.4%)

28,794 (55.3%)

35,396 (56.0%)

33,743 (58.4%)

32,040 (56.6%)

Median household income quartile*

First

20,831 (53.1%)

20,296 (45.1%)

20,573 (47.9%)

23,467 (49.0%)

24,161 (50.6%)

23,066 (45.7%)

29,583 (48.6%)

26,803 (47.3%)

26,780 (48.4%)

Second

8,907 (22.7%)

10,876 (24.2%)

10,595 (24.7%)

11,028 (23.0%)

10,494 (22.0%)

12,915 (25.6%)

14,466 (23.8%)

12,076 (21.3%)

12,055 (21.8%)

Third

5,395 (13.8%)

8,281 (18.4%)

7,434 (17.3%)

7,896 (16.5%)

8,054 (16.9%)

8,175 (16.2%)

10,274 (16.9%)

11,420 (20.1%)

9,830 (17.8%)

Fourth

4,071 (10.4%)

5,501 (12.2%)

4,314 (10.1%)

5,464 (11.4%)

5,034 (10.5%)

6,319 (12.5%)

6,541 (10.7%)

6,402 (11.3%)

6,690 (12.1%)

In-hospital mortality, N (%)†

409 (1.03%)

401 (0.87%)

459 (1.05%)

473 (0.96%)

440 (0.90%)

490 (0.94%)

534 (0.84%)

494 (0.85%)

575 (1.02%)

Primary payer*

Medicare

10,028 (25.3%)

10,966 (23.9%)

11,812 (26.9%)

13,407 (27.2%)

13,283 (27.4%)

15,183 (29.2%)

17,078 (27.1%)

18,729 (32.4%)

17,500 (31.0%)

Medicaid

20,151 (50.9%)

22,720 (49.5%)

20,648 (47.0%)

22,116 (44.8%)

20,070 (47.5%)

24,029 (46.1%)

29,722 (27.1%)

25,298 (43.8%)

25,910 (45.8%)

Private

7,073 (17.9%)

9,045 (19.7%)

8,670 (19.8%)

9,204 (18.7%)

9,046 (18.6%)

8,790 (16.9%)

12,065 (19.1%)

10,420 (18.0%)

9,390 (16.6%)

Self-pay

1,290 (3.3%)

1,587 (3.5%)

1309 (3.0%)

2,231 (4.5%)

1,894 (3.9%)

2,559 (4.9%)

2,498 (4.0%)

1,916 (3.3%)

2,045 (3.6%)

No charge

163 (0.4%)

208 (0.5%)

31 (0.1%)

406 (0.8%)

202 (0.4%)

207 (0.4%)

223 (0.4%)

136 (0.2%)

165 (0.3%)

Admission type*

Emergency

28,159 (75.3%)

31,167 (72.8%)

31,285 (76.6%)

36,117 (76.7%)

35,150 (78.4%)

35,852 (74.5%)

45,337 (75.6%)

41,226 (76.4%)

N/A

Urgent

5,665 (15.1%)

6,404 (15.0%)

5,944 (14.6%)

6,535 (13.9%)

5,566 (12.4%)

8,812 (18.3%)

9,008 (15.0%)

8,388 (15.6%)

Elective

3,558 (9.5%)

4,803 (11.2%)

3,601 (8.8%)

4,405 (9.4%)

4,108 (9.2%)

3,433 (7.1%)

5,592 (9.3%)

4,276 (7.9%)

Location & teaching status of hospital*

Rural

1,929 (4.8%)

2,858 (6.2%)

2,470 (5.6%)

3,071 (6.2%)

2,744 (5.6%)

2,483 (4.9%)

3,219 (5.2%)

4,085 (7.2%)

2,475 (4.4%)

Urban nonteach.

11,704 (29.4%)

12,390 (27.0%)

12,068 (27.5%)

14,693 (29.8%)

14,396 (29.6%)

15,373 (30.6%)

14,431 (23.3%)

16,932 (29.7%)

14,980 (26.5%)

Urban teach.

26,168 (65.7%)

30,709 (66.8%)

29,304 (66.8%)

31,617 (64.0%)

31,499 (64.8%)

32,371 (64.4%)

44,460 (71.6%)

36,087 (63.2%)

39,180 (69.2%)

Region of hospital*

Northeast

8,168 (20.5%)

8,386 (18.2%)

10,878 (24.8%)

7,938 (16.1%)

9,238 (19.0%)

9,676 (18.5%)

12,157 (19.2%)

11,308 (19.5%)

11,165 (19.7%)

Midwest

7,338 (18.4%)

8,859 (19.3%)

7,724 (17.6%)

8,284 (16.8%)

6,396 (13.2%)

11,386 (21.8%)

9,920 (15.7%)

10,114 (17.5%)

10,355 (18.3%)

South

21,398 (53.8%)

24,353 (53.0%)

21,164 (48.2%)

29,550 (59.8%)

27,559 (56.7%)

25,769 (49.4%)

36,709 (58.0%)

31,326 (54.1%)

29,280 (51.7%)

West

2,898 (7.3%)

4,359 (9.5%)

4,150 (9.4%)

3,668 (7.4%)

5,446 (11.2%)

5,350 (10.3%)

4,492 (7.1%)

5,112 (8.8%)

5,835 (10.3%)

Age, years**, mean ± SD, median (IQR)

28.7 ± 14.5, 27 (20 - 38)

27.4 ± 15.1, 26 (17 - 37)

29.68 ± 14.44, 28 (20 - 39)

29.65 ± 14.35, 28 (21 - 39)

29.64 ± 14.50, 28 (21 - 39)

30.30 ± 14.29, 29 (22 - 40)

28.77 ± 14.73, 27 (20 - 37)

31.47 ± 14.21, 30 (22 - 40)

30.34 ± 14.84, 29 (22 - 39)

LOS, days**, mean ± SD, median (IQR)

7.12 ± 7.65, 5 (3 - 9)

7.08 ± 8.24 5 (3 - 8)

7.05 ± 7.94, 5 (3 - 9)

6.97 ± 7.49, 5 (3 - 8)

6.61 ± 6.85, 5 (3 - 8)

6.46 ± 6.25, 5 (3 - 8)

6.40 ± 6.43, 5 (3 - 8)

6.37 ± 7.16, 5 (3 - 8)

6.23 ± 6.42, 5 (3 -8)

Charges, thousand dollars**, mean ± SD, median (IQR)

25.36 ± 37.91, 15.35 (8.99 - 27.57)

27.33 ± 39.83, 16.32 (9.19 - 29.96)

29.86 ± 41.64, 18.15 (10.39 - 34.09)

33.38 ± 49.69, 20.51 (11.66 - 36.88)

30.98 ± 44.57, 19.26 (11.45 - 35.19)

35.32 ± 47.72, 21.95 (12.47 - 39.75)

35.49 ± 50.34, 22.14 (12.80 - 40.48)

39.03 ± 80.02, 23.54 (13.81 - 42.37)

41.32 ± 68.74, 24.78 (14.37 - 45.24)