P4.051: Acute Chest Syndrome Among Medicaid-insured African-american Children With Sickle Cell Disease; Analyzing the Trends in Admission and Impact of the Pandemic

Background: Acute chest syndrome(ACS) is a complication frequently seen in children with sickle cell disease(SCD) who are mainly insured via Medicaid and particularly involves African American(AA) patients. This retrospective study aims to understand the prevalence of ACS among Medicaid-insured AA-SCD admissions, along with the age distribution, the impact of the COVID-19 pandemic, and the healthcare burden.

Methods: We analyzed hospitalizations of Medicaid-insured AA children ( < 18 years) with SCD using the hospitalization data from the National Inpatient Sample(NIS), which is part of the Healthcare Cost and Utilization Project (HCUP). We identified patients with ACS and COVID-19 using ICD-10 codes. We then estimated the trends in ACS cases per 100,000 SCD admissions by examining the overall trends and then stratifying our analysis for non-COVID-19 and COVID-19 admissions. Finally, we calculated the age-based ACS rates among SCD cases(without COVID) and the total hospital charges.

Results: We studied 93085 SCD admissions with 15965 ACS cases(17151 per 100,000). The presence of ACS among all SCD admissions rose between 2016 (13827 per 100,000) and 2019 (18617 per 100,000). In 2020 and 2021, the incidence of ACS among all SCD admissions and non-COVID SCD admissions dropped (Figure 1a), and in 2022, they both rose again(ptrend < 0.01 for both). The highest rate of ACS among COVID-19-positive SCD admissions was seen in 2020 (41176 per 100,000), while it was 36522 per 100,000 in 2021 and 27315 per 100,000 in 2022. Our study further found that among all non-COVID SCD admissions, the highest rate of ACS was reported among children ages 6 years(25481 per 100,000 non-COVID SCD admissions)(Figure 1b). The total hospital charges for non-COVID ACS admissions were $891,154,531(2016-2022), with an average of $127,307,790/year, while the total hospital charges for COVID-19-positive ACS patients were $35,157,153(2020-2022).

Conclusion: This analysis confirms that ACS remains a major health concern for SCD patients particularly with higher incidence among COVID-19. Although ACS rates declined in non COVID-19 cases during earlier pandemic years, they increased again in 2022, highlighting shifting trends. The study also shows the financial burden of ACS, particularly for non COVID-19 cases. These findings emphasize the need for continued research to better understand risk factors and improve health outcomes.