Racial and ethnic differences in sickle cell disease within the United States: From demographics to outcomes

Introduction: Sickle cell disease mainly affects African Americans, and studies on racial differences in sickle cell disease outcomes are scanty. This study examined racial and ethnic differences in sickle cell disease prevalence, comorbidities, and outcomes.Methods: Using the National Inpatient Sample database from 2016 to 2018, we identified patients' records with a diagnosis of sickle cell disease using the International Classification of Diseases, Tenth Revision codes. The overall study population was further stratified by race into Blacks, Whites, and Hispanics. Using logistic regression, comorbidities and outcomes among sickle cell disease patients were compared between the three races/ethnicities.Results: Of the 74 817 hospitalized for sickle cell disease, 69 889 (93.4%) were Blacks, 3603 (4.8%) were Hispanics, and 1325 (1.8%) were Whites. Compared to Whites, Blacks were more likely to have significantly higher odds of sickle cell crisis (odds ratio [OR]: 3.32; 95% confidence interval [CI]: 2.66-4.14) and blood transfusion (OR: 1.66; 95% CI: 1.37-2.02). There was no difference in mortality between Blacks and Whites. Compared to Hispanics, Blacks had significantly higher odds of sickle cell crisis (OR: 1.35; 95% CI: 1.19-1.53) and blindness (OR: 2.94; 95% CI: 1.22-7.11), lower odds of asplenia (OR: 0.57; 95% CI: 0.45-0.71) and gallstones (OR: 0.75; 95% CI: 0.58-0.95). However, Blacks had statistically significantly lower odds of mortality of 0.60 (95% CI: 0.38-0.93) than Hispanics.Conclusion: Prevalent sickle cell type, severity, complications, and comorbidities vary in different races. Physicians need to be aware of these differences to manage sickle cell patients efficiently. This study hopes to inform further research regarding the reasons for varying disease characteristics among racial groups and bridge a gap in tailored management protocols.