PDF(Pubmed)
Abstract：
BACKGROUND: Chronic kidney disease (CKD) is a significant complication in patients with sickle cell disease (SCD), leading to increased mortality.
OBJECTIVE: This study aims to investigate the burden of CKD in Medicaid-enrolled adults with SCD in California, examine differences in disease burden between male and female individuals, and assess mortality rates and access to specialized care.
METHODS: This retrospective cohort study used the California Sickle Cell Data Collection program to identify and monitor individuals with SCD. Medicaid claims, vital records, emergency department, and hospitalization data from 2011 to 2020 were analyzed. CKD prevalence was assessed based on ICD (International Classification of Diseases) codes, and mortality rates were calculated. Access to specialized care was examined through outpatient encounter rates with hematologists and nephrologists.
RESULTS: Among the 2345 adults with SCD, 24.4% (n=572) met the case definition for CKD. The SCD-CKD group was older at the beginning of this study (average age 44, SD 14 vs 34, SD 12.6 years) than the group without CKD. CKD prevalence increased with age, revealing significant disparities by sex. While the youngest (18-29 years) and oldest (>65 years) groups showed similar CKD prevalences between sexes (female: 12/111, 10.8% and male: 12/101, 11.9%; female: 74/147, 50.3% and male: 34/66, 51.5%, respectively), male individuals in the aged 30-59 years bracket exhibited significantly higher rates than female individuals (30-39 years: 49/294, 16.7%, P=.01; 40-49 years: 52/182, 28.6%, P=.02; and 50-59 years: 76/157,48.4%, P<.001). During this study, of the 2345 adults, 435 (18.5%) deaths occurred, predominantly within the SCD-CKD cohort (226/435, 39.5%). The median age at death was 53 (IQR 61-44) years for the SCD-CKD group compared to 43 (IQR 33-56) years for the SCD group, with male individuals in the SCD-CKD group showing significantly higher mortality rates (111/242, 45.9%; P=.009) than female individuals (115/330, 34.9%). Access to specialist care was notably limited: approximately half (281/572, 49.1%) of the SCD-CKD cohort had no hematologist visits, and 61.9% (354/572) did not see a nephrologist during this study\'s period.
CONCLUSIONS: This study provides robust estimates of CKD prevalence and mortality among Medicaid-enrolled adults with SCD in California. The findings highlight the need for improved access to specialized care for this population and increased awareness of the high mortality risk and progression associated with CKD.
OBJECTIVE: This study aims to investigate the burden of CKD in Medicaid-enrolled adults with SCD in California, examine differences in disease burden between male and female individuals, and assess mortality rates and access to specialized care.
METHODS: This retrospective cohort study used the California Sickle Cell Data Collection program to identify and monitor individuals with SCD. Medicaid claims, vital records, emergency department, and hospitalization data from 2011 to 2020 were analyzed. CKD prevalence was assessed based on ICD (International Classification of Diseases) codes, and mortality rates were calculated. Access to specialized care was examined through outpatient encounter rates with hematologists and nephrologists.
RESULTS: Among the 2345 adults with SCD, 24.4% (n=572) met the case definition for CKD. The SCD-CKD group was older at the beginning of this study (average age 44, SD 14 vs 34, SD 12.6 years) than the group without CKD. CKD prevalence increased with age, revealing significant disparities by sex. While the youngest (18-29 years) and oldest (>65 years) groups showed similar CKD prevalences between sexes (female: 12/111, 10.8% and male: 12/101, 11.9%; female: 74/147, 50.3% and male: 34/66, 51.5%, respectively), male individuals in the aged 30-59 years bracket exhibited significantly higher rates than female individuals (30-39 years: 49/294, 16.7%, P=.01; 40-49 years: 52/182, 28.6%, P=.02; and 50-59 years: 76/157,48.4%, P<.001). During this study, of the 2345 adults, 435 (18.5%) deaths occurred, predominantly within the SCD-CKD cohort (226/435, 39.5%). The median age at death was 53 (IQR 61-44) years for the SCD-CKD group compared to 43 (IQR 33-56) years for the SCD group, with male individuals in the SCD-CKD group showing significantly higher mortality rates (111/242, 45.9%; P=.009) than female individuals (115/330, 34.9%). Access to specialist care was notably limited: approximately half (281/572, 49.1%) of the SCD-CKD cohort had no hematologist visits, and 61.9% (354/572) did not see a nephrologist during this study\'s period.
CONCLUSIONS: This study provides robust estimates of CKD prevalence and mortality among Medicaid-enrolled adults with SCD in California. The findings highlight the need for improved access to specialized care for this population and increased awareness of the high mortality risk and progression associated with CKD.
摘要：
背景：慢性肾脏病（CKD）是镰状细胞病（SCD）患者的重要并发症，导致死亡率上升。
目的：本研究旨在调查在加州接受医疗补助的SCD成人的CKD负担。检查男性和女性个体之间疾病负担的差异，并评估死亡率和获得专门护理的机会。
方法：这项回顾性队列研究使用加州镰状细胞数据收集计划来识别和监测患有SCD的个体。医疗补助声称，重要记录,急诊科,并对2011年至2020年的住院数据进行分析。CKD患病率根据ICD（国际疾病分类）代码进行评估。并计算了死亡率。通过与血液学家和肾脏病学家的门诊就诊率来检查获得专门护理的机会。
结果：在2345名患有SCD的成年人中，24.4%(n=572)符合CKD病例定义。在本研究开始时，SCD-CKD组比无CKD组年龄大（平均年龄44岁，SD14vs34岁，SD12.6岁）。CKD患病率随年龄增长而增加,揭示了性别的显著差异。而年龄最小（18-29岁）和年龄最大（>65岁）组的CKD患病率在性别之间相似（女性：12/111，10.8％，男性：12/101，11.9％；女性：74/147，50.3％，男性：34/66，51.5％，分别)，男性在30-59岁人群中的发病率明显高于女性(30-39岁:49/294，16.7%，P=0.01；40-49岁：52/182，28.6%，P=.02；50-59岁：76/157,48.4%，P<.001)。在这项研究中,2345名成年人中,发生435例（18.5%）死亡，主要在SCD-CKD队列中（226/435，39.5%）。SCD-CKD组的中位死亡年龄为53（IQR61-44）岁，而SCD组的中位死亡年龄为43（IQR33-56）岁，SCD-CKD组中男性个体的死亡率(111/242,45.9%;P=.009)显著高于女性个体(115/330,34.9%).获得专科护理的机会非常有限：大约一半（281/572，49.1%）的SCD-CKD队列没有血液学家就诊。61.9%(354/572)在本研究期间没有看到肾脏科医生。
结论：这项研究提供了在加利福尼亚州医疗补助招募的SCD成人中CKD患病率和死亡率的稳健估计。研究结果强调，需要改善该人群获得专门护理的机会，并提高对CKD相关的高死亡风险和进展的认识。
目的：本研究旨在调查在加州接受医疗补助的SCD成人的CKD负担。检查男性和女性个体之间疾病负担的差异，并评估死亡率和获得专门护理的机会。
方法：这项回顾性队列研究使用加州镰状细胞数据收集计划来识别和监测患有SCD的个体。医疗补助声称，重要记录,急诊科,并对2011年至2020年的住院数据进行分析。CKD患病率根据ICD（国际疾病分类）代码进行评估。并计算了死亡率。通过与血液学家和肾脏病学家的门诊就诊率来检查获得专门护理的机会。
结果：在2345名患有SCD的成年人中，24.4%(n=572)符合CKD病例定义。在本研究开始时，SCD-CKD组比无CKD组年龄大（平均年龄44岁，SD14vs34岁，SD12.6岁）。CKD患病率随年龄增长而增加,揭示了性别的显著差异。而年龄最小（18-29岁）和年龄最大（>65岁）组的CKD患病率在性别之间相似（女性：12/111，10.8％，男性：12/101，11.9％；女性：74/147，50.3％，男性：34/66，51.5％，分别)，男性在30-59岁人群中的发病率明显高于女性(30-39岁:49/294，16.7%，P=0.01；40-49岁：52/182，28.6%，P=.02；50-59岁：76/157,48.4%，P<.001)。在这项研究中,2345名成年人中,发生435例（18.5%）死亡，主要在SCD-CKD队列中（226/435，39.5%）。SCD-CKD组的中位死亡年龄为53（IQR61-44）岁，而SCD组的中位死亡年龄为43（IQR33-56）岁，SCD-CKD组中男性个体的死亡率(111/242,45.9%;P=.009)显著高于女性个体(115/330,34.9%).获得专科护理的机会非常有限：大约一半（281/572，49.1%）的SCD-CKD队列没有血液学家就诊。61.9%(354/572)在本研究期间没有看到肾脏科医生。
结论：这项研究提供了在加利福尼亚州医疗补助招募的SCD成人中CKD患病率和死亡率的稳健估计。研究结果强调，需要改善该人群获得专门护理的机会，并提高对CKD相关的高死亡风险和进展的认识。
