Racial and socioeconomic disparities in transfusion utilization among hospitalized sickle cell disease patients: An analysis of the 2022 national inpatient sample

Abstract Background Sickle cell disease (SCD) often requires inpatient management for acute complications, including severe anemia, vaso-occlusive crises, and acute chest syndrome. Transfusion therapy, while commonly used during hospitalizations, is little known by ethnicity, hospital status and regions in the United States. Furthermore, disparities in outcomes such as inpatient mortality and intensive care utilization remain underexplored at the national level. We evaluated differences in transfusion rates, mortality, and ICU-level care among SCD-related hospitalizations using 2022 National Inpatient Sample (NIS).Methods We used ICD-10-CM codes beginning with D57, excluding sickle cell trait (D573). Transfusions were identified via ICD-10-PCS codes starting with 3023, 3024, or 3025. ICU-level interventions were approximated using proxy procedure codes including mechanical ventilation, intubation, and central line placement codes starting with 5A1, 0BH1, 05H, respectively. Inpatient mortality was defined by discharge status in NIS (DIED=1). Survey design specifications included clustering (HOSP_NIS), stratification (NIS_STRATUM), and discharge-level weighting (DISCWT). We used survey-weighted logistic regression to assess predictors of transfusion and descriptive statistics to quantify mortality and ICU proxy use across hospital types and regions.Results We identified an estimated 120,275 SCD-related hospitalizations. The racial distribution was Black (91%), Hispanic (5%), White (1.6%), and Other (2.6%). Overall transfusion rate 21.0%. Adjusted odds ratios (AOR) compared to White patients showed Black of AOR 2.40 (95% CI: 1.68-3.43), Hispanic of AOR 2.77 (95% CI: 1.87-4.10), and other races of AOR 2.09 (95% CI: 1.35-3.23). Transfusion rate is highest in rural hospitals (30.3%), and lowest in urban teaching hospitals (20.9%). Geographically, the Midwest had the lowest transfusion rate (14.5%). Overall inpatient mortality was 2.1 per 1,000 discharges. Inpatient mortality was highest in Midwest (3.4/1,000) and lowest in South (1.7/1,000) by region. National ICU proxy showed 3.7% of ICU admission of the total discharges, and highest in Midwest (5.1%), and lowest in South (2.8%).Conclusions Among hospitalized SCD patients, significant disparities exist in transfusion utilization, inpatient mortality, and ICU-level intervention use. Black and Hispanic patients were more likely to receive transfusions than White patients, even after adjustment. Urban teaching hospitals treated the majority of SCD cases but had lower transfusion rates. The Midwest region consistently showed the lowest transfusion utilization and the highest rates of ICU proxy use and mortality, suggesting a potential care gap. These findings highlight the need for standardized inpatient protocols and equity-focused quality improvement efforts in SCD care.