Abstract
IntroductionStroke is 10 times more common in adults with Sickle Cell Disease (SCD) than those without. Although the Stroke Prevention trial in Sickle cell Anemia helped decrease incidence of pediatric strokes in SCD, there have been no major advancements in adult strokes in SCD.HypothesisStroke related admissions in patients with SCD has increased in the last decade.MethodsUsing ICD 9/10 codes SCD admissions were stratified according to demographics and further delineated into those for strokes; classified as hemorrhagic or ischemic. Multivariable logistic regression model was used to identify predictors of in-hospital mortality, and age-adjusted annual incidence stroke trends were examined from 2002-2016. SAS v. 9.4 and Joinpoint Trend Analysis v. 4.5 software were used.ResultsOf a total of 1,003,063 SCD patients, 5,671 were admitted for strokes. These were associated with an older median age (44.3 years vs. 31.2 years; p < 0.0001), increased median length of stay (6.5 days vs. 4.3 days; p < 0.0001) and increased in-hospital mortality (10.7% vs. 0.6%; p < 0.0001). Approximately 75% of the strokes were hemorrhagic and 13% ischemic. Of the 607 deaths, 80% were African Americans and 44% in the lowest income quartile. After adjusting for Elixhauser mortality score and variables like ethnicity and income level, stroke admissions were found to have 11.6 times increased odds of in-hospital mortality (95% CI8.8 to 15.2; p < 0.0001). Finally a 24.1% annual increase in SCD stroke admissions was found from 2009-2014 (95% CI7.1% to 43.8%; p = 0.0105).ConclusionOur study shows increasing rate of stroke hospitalizations amongst adult SCD patients, with longer length of stay and higher mortality. Life expectancy in SCD has nearly doubled in the last four decades and today stroke carries one of the highest mortality rates in SCD. SCD has higher prevalence amongst African Americans and addressing the stroke burden would help towards addressing healthcare disparities in this group.