Role of social disparity in 30-day readmissions and healthcare utilization in patients with history of sickle cell crisis in United States: Cross-sectional analysis from US national database.

person Urja Nagadia University of Missouri, Columbia, MO info_outline Urja Nagadia, Sanket Basida, Swathi Radhakrishnan, Lakshmi Ramya Chelapareddy, Kushal Naha

Authors person Urja Nagadia University of Missouri, Columbia, MO info_outline Urja Nagadia, Sanket Basida, Swathi Radhakrishnan, Lakshmi Ramya Chelapareddy, Kushal Naha Organizations University of Missouri, Columbia, MO, University of Missouri Hospital, Columbia, MO Abstract Disclosures Research Funding No funding received None. Background: Factors like age, mental status, spirituality, financial security, and clinic attendance affect hospital admissions/readmissions in sickle cell disease patients. To further understand the predisposing factors associated with increased readmissions in sickle cell disease patients, this study examined the relationship between readmission rates and socioeconomic status of Sickle cell patients in the US. Methods: All adult hospitalized patients in the Nationwide Readmission Database (NRD) for the year 2019 were captured. The sample population included all patients with primary diagnosis of Sickle cell crisis, identified using ICD-10 codes (International Classification of Diseases, tenth edition). We used the Wilcoxon rank sum test to compare continuous variables and chi square test for categorical variables. Predictors of readmission were analyzed using multivariate logistic regression models. We used StataCorp LLC MP4 17 version to perform statistical analysis. Results: The sample size included 48,715 patients admitted with sickle cell crisis, of which 55.12% were females and 44.88% were males. The mean age of presentation was 32.84 years. The rate of all cause 30-day readmission in patients admitted with Sickle cell crisis was 27.19%. The total hospital charges for these readmitted patients during the year 2019 was 507 million dollars and total length of stay was 69,418 days (about 190 years). The most common causes of readmissions were Sickle cell crisis including Acute chest syndrome and splenic sequestration crisis, followed by sepsis due to MRSA and femoral fractures. After adjusting for confounders on multivariate analysis, compared to patients belonging to income category 1 ( < $46,000), patients in category 2 ($46,000-$58,999) had 11% lower risk (p-value 0.018) and category 3 had 16% lower risk (p-value 0.008) of 30-day readmission. However, there was no increased risk of death based on socioeconomic status (OR 1.03, p-value 0.875). Conclusions: Our study concludes that socioeconomically deprived Sickle cell crisis patients are at higher risk of readmissions. Factors like poor living situation, lack of means for transportation, potential lower level of education leading to decreased medication compliance and clinic follow ups could be attributed to these findings. Interventions targeting this population can help reduce healthcare burden and patient morbidity significantly. Readmission Adjusted Odds ratio* 95% CI p-value Median Income Quartile < $45,999 (Reference) $46,000-$58,999 0.89 0.82 – 0.98 0.018 $59,000-$78,999 0.93 0.85 - 1.03 0.182 > $79,000 0.84 0.73 – 0.95 0.008 *adjusted for age,sex,hospital bed size and Elix Hauser comorbidity index.