The U.S. opioid epidemic is not linked to higher in-hospital mortality in patients with sickle cell disease (SCD), according to a national study.
The study came about due to the pronounced increase in opioid-related overdoses and deaths in the U.S. that has been reported since 2000. Its researchers did find increased hospitalization rates in young adult and elderly SCD patients, but not in deaths linked to opioids used to control disease-related pain.
“Opioid Use Is NOT Associated with in-Hospital Mortality Among Patients with Sickle CELL Disease in the United States: Findings from the National Inpatient Sample,” was recently presented at the 60th American Society of Hematology (ASH) Annual Meeting, in San Diego.
Most hospitalizations in SCD patients are due to vaso-occlusive pain crises — the blockage of small blood vessels that prevents oxygen supply to tissues, and causes injury. Opioids are the standard treatment for chronic pain in SCD.
Scientists with Boston University School of Medicine, Boston Medical Center and Vanderbilt University Medical Center assessed trends in hospitalization and in-hospital mortality rates in adults with SCD since the onset of the opioid epidemic. They also compared in-hospital mortality rates in SCD patients with the rates of opioid prescription-associated deaths in the general population.
They collected data from the National Inpatient Sample from 1998 to 2013. Analyses of the whole SCD group as well as of subgroups defined by age — 0-17 years, 18-44 years, 45-64 years, and 65 years or older — were conducted. In-hospital mortality and hospitalization trends were also examined in specific U.S regions: the Northeast, Midwest, South, and West.
A total of 1,755,220 hospitalizations was found among SCD patients in this time period. Hospitalization rates in this patient population initially lowered annually by 9.9% from 39/100,000 persons in 1998 to 27/100,000 persons in 2002, but no significant trends were noted between 2002 and 2013.
In contrast, hospitalization rates of young adults with SCD (18-44 years) significantly increased yearly by 3.8% from 43/100,000 persons in 2002 to 71/100,000 persons in 2013. A 6.5% annual increase was observed in patients 65 years or older from 2.7/100,000 persons in 1998 to 5.4/100,000 persons in 2013.
The South was the only region with a significant overall rise in the SCD hospitalization rate, with an annual increase of 3.5% from 2001 through 2011.
No significant increase in deaths among hospitalized SCD patients was observed, in sharp contrast with the 350% rise in the opioid prescription-related death rate in the U.S. between 1999 and 2013.
Overall, the higher hospitalization rate in different patient age groups “may reflect the fragmentation of care for SCD in adults” and “age-related increases in pain-related comorbidities and SCD complications as SCD patients live longer,” the researchers suggested.
The lack of increased in-hospital SCD mortality is also in line with data “which suggest that the rate of opioid-related deaths in SCD is low, and the use of opioids for pain control may be considered relatively safe in the SCD population,” they added.
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