Abstract TP192: Trends in Hospital Admissions for Stroke Among Patients With Sickle Cell Disease

Abstract

Introduction: Sickle cell disease (SCD) is a major risk factor for ischemic and hemorrhagic stroke. Approximately 10% of children with SCD will have a stroke, a rate that increases to nearly 25% by age 45. In adults with SCD, stroke management guidelines are limited and recent national trends in hospital admission and mortality are not known. We sought to describe the recent trends in national hospital admissions for ischemic stroke, associated mortality and other socio-demographic traits, among adult patients with SCD. Methods: The National Inpatient Sample (NIS) is a healthcare database that approximates a 20 percent stratified sample of all hospital discharges in the US. We queried the NIS from 2006-2014 using ICD-9 codes for a primary diagnosis of ischemic stroke and any secondary diagnosis of SCD. Our primary outcomes were hospital admission rates and mortality. We stratified admissions by presence of SCD and accounted for race (AA, Hispanic, NHW and other), sex, age, hospital characteristics, US region, household income, insurance type, disease severity and other factors using multivariable logistic regression. Results: We found a total of 1,052,442 observations for ischemic stroke from 2006-2014, of which 743 had a secondary diagnosis of SCD. Ischemic stroke and SCD accounted for 0.32% of all hospitalization in blacks, compared to 0.04 in whites and Hispanics each. Patients with both diagnoses were also much more likely to be younger, accounting for 0.57% of all admission in those 18-44 compared to only 0.02% in those older than 65. In the adjusted model, stroke admission rates among patients with SCD steadily declined from 2006-2008 compared to 2012-2014 (OR 0.82, CI 0.789-0.86). There was no difference in hospital mortality for patients with SCD compared to those without it (OR 1.2, CI 0.84-1.6). Having medicaid was associated with increased in mortality (OR 1.43, CI 1.37-1.51) and so was income, with the first quartile in income having the highest mortality OR 1.03, CI 1.01-1.05). Conclusion: Hospital admissions for ischemic stroke in adults with SCD have declined from 2006 to 2014. SCD remains an under-recognized stroke risk factor in young AA. Insurance type and income were associated with increased mortality.