Children with sickle cell anemia, using Medicaid less likely to have stroke screening and pain treatment

In 2019, less than half of children ages 2 to 16 with sickle cell anemia received the recommended screening for stroke, a common complication of the disease.

Few children Sickle cell anemia The CDC said Tuesday that its Medicaid-covered health care providers are not getting the recommended screening they need to prevent stroke or receiving recommended pain medications.

Sickle cell anemia is the most severe and common subtype of sickle cell disease (SCD), and in 2014, an expert panel convened by the National Heart, Lung, and Blood Institute issued recommendations to prevent or reduce complications in children and adolescents with sickle cell anemia.

Recommendations included annual screening of children and adolescents aged 2-16 years using transcranial ultrasound (TCD) to identify those at risk of stroke and the introduction of hydroxyurea therapy for children and adolescents 9 months and older to reduce pain and acute chest syndrome. Hydroxyurea can also improve anemia and quality of life.

The red blood cell disorder affects nearly 100,000 Americans, mostly blacks and African Americans. It is already known that the two recommendations have not been sufficiently utilized due to various drawbacks.

In this study published in Weekly morbidity and mortality report (MMWR), researchers analyzed the IBM MarketScan Multi-State Medicaid database, from January 1, 2010 to December 13, 2019, which includes medical claims data for nearly 24 million Medicaid enrollees from 5 to 15 states (the number of states varies by general). TCD screening and hydroxyurea use were determined on the basis of procedures and pharmacy codes.

TCD screening and hydroxyurea use were examined for 3,352 children and adolescents with SCA aged 2 to 16 years who were consistently enrolled in Medicaid during 2019. Percentage change over 2014 to 2019 and difference by health subgroups were assessed, and Break down the analyzes by age.

In 2019, less than half of children ages 2 to 16 with sickle cell anemia received the recommended screening for stroke, a common complication of the disease.

Overall, TCD screening increased from 30% to 38% from 2014 to 2019 among children ages 2 to 9. Among children aged 10 to 16 years, there was an increase from 43% to 53%.

For hydroxyurea use during the same time period for the younger age group, the increase was similar (from 30% to 38%). For the older age group, hydroxyurea use increased from 43% to 53%.

Both stroke screening and hydroxyurea use were higher among children with high levels of healthcare use, including those who already had pre-existing comorbid complications.

Hydroxyurea use exceeded 60% among children and adolescents aged 10 to 16 years if they had:

  • Recent hospitalization
  • 11 to 30 recent ambulatory care visits
  • 3 or more visits to the emergency department (ED)
  • Recent or previous hospitalization for acute chest syndrome
  • 2 or more pain crises requiring hospitalization in the current or previous year

Hydroxyurea use was higher (47%-58%) in the same subgroups in the younger age group, except for a slight difference in hydroxyurea use by number of ED visits.

Many patients with sickle cell anemia cited barriers to receiving recommended screening and treatment, and barriers due to structural racism. Patients reported feeling stigmatized, having their symptoms ignored when they received care, or not having access to sickle cell specialists. Other barriers include concerns among parents and providers about the potential adverse effects and efficacy of hydroxyurea.

“We must take action to ensure that children with sickle cell anemia receive potentially life-saving treatment,” CDC Acting Deputy Director Debra Houry, MD, MPH, He said in a statement. The pain and complications experienced by these children can be excruciating and debilitating and can last for hours, days, or even weeks. Preventive care and medications, such as hydroxyurea, can help ease the pain and suffering these children go through, and may extend their lives.”

The researchers recommended that healthcare systems implement high-quality care strategies and build accountability in electronic health records. It is also important, they said, that “strategies include proactively addressing both personal and structural racism.” Additionally, expanding surveillance coverage, which is currently limited to a few states, would allow the CDC to better understand patient needs and disease outcomes.

reference

Schieve LA, Simmons GM, Payne AB et al. Use of Recommended Healthcare Measures to Prevent Selected Complications of Sickle Cell Anemia in Children and Adolescents – Selected US States, 2019. MMWR Morb Mortal Wkly Rep. Published online September 20, 2022. doi: 10.15585 / mmwr.mm7139e1