Healthcare Utilization Patterns in Sickle Cell Patients and Their Association With Sickle Cell Retinopathy

Background/aim: A few shave identified systemic and hematologic risk factors for Proliferative Sickle Cell Retinopathy (PSR) development. The relevance of healthcare utilization as a risk factor for PSR has not been defined. This study evaluates patterns of healthcare utilization among patients with sickle cell disease (SCD) and retinopathy.

Methods: A retrospective study of adults with SCD, using EMR, was conducted from January 2017 to December 2019, seen at the Montefiore Medical Center eye clinic.

Results: Four hundred twelve patients with SCD were included in this analysis (65.8% HbSS (SS)) and 34.2% HbSC (SC). HBSS patients had higher utilization of hematology outpatient visits and inpatient admissions than HBSC. For individuals with either HBSC or HBSS disease, higher outpatient healthcare utilization was associated with higher number of inpatient admissions. The prevalence of retinopathy was 24% and 55% in SS and SC patients respectively, with PSR in 60% SS and 87.6% SC of these patients. Patients with HBSC with higher outpatient visits and inpatient admissions experienced significantly lower PSR rates. In contrast, for patients with HBSS, higher outpatient visits were significantly associated with higher PSR prevalence.

Conclusion: Healthcare utilization patterns in individuals with HBSS and HBSC varied according to their prevalence of PSR. These differences may be useful in stratifying patients' risk for retinopathy development and in deciding follow-up eye examination frequency.