Trends in comorbid sickle cell disease among stroke patients

Abstract 

Background

Stroke is a major complication of sickle cell disease (SCD). In an era of chronic red cell transfusions for stroke prophylaxis in children and greater life expectancy, nationwide data on stroke rates among pediatric and adult patients with SCD are scarce. We evaluated recent time trends in stroke hospitalization among children (0–17years) and adults (>17years) with SCD in the United States.

Methods

Data were obtained from the Nationwide Inpatient Sample. Pediatric (n=26,380) and adult (n=9,638,507) patients admitted to hospitals between 1997 and 2006 with a primary stroke discharge diagnosis (identified by the International Classification of Diseases, Ninth Revision procedure codes) were included. Time trends in the proportion of stroke patients with SCD were computed.

Results

Pediatric stroke patients with co-morbid SCD constituted 8.7% in 1997 vs. 4.8% in 2006 (p=0.04), with 81 fewer actual hospitalizations. Adult stroke patients with SCD were 0.3% in 1997 vs. 0.5% in 2006 (p=0.01), with 157 more actual hospitalizations. Factors that changed substantially and significantly across the decade among pediatric stroke patients with SCD included a drop in ischemic stroke type (74.2% vs. 56.3%) and a rise in comorbid hypertension (1.5% vs. 11.5%), while among adult stroke patients with SCD there was a rise in other stroke type (20.4% vs. 35.6%).

Conclusions

In an era of increasing prophylactic red cell transfusions, the proportion of SCD diagnoses among pediatric stroke patients significantly decreased in the United States. The rise in SCD diagnoses among adult stroke patients is possibly due to a cohort effect, but further study is needed.

Keywords: Sickle cell disease, Cerebral ischemia, Stroke, Subarachnoid hemorrhage, Intracerebral hemorrhage, Incidence, Hospitalization, United States, Population, Outcomes, Epidemiology, Trends, Patterns, Diagnosis, Ischemic stroke, Cerebrovascular disease