Sex disparities in sickle cell disease admissions in United States: A national in-patient sample study from 2016-2022

Abstract Background: Sickle cell disease (SCD) is a chronic, inherited hemoglobinopathy associated with significant morbidity and mortality. While previous studies have focused on the overall burden of SCD, limited research has explored the influence of gender on disease outcomes, healthcare utilization, and access to care. Objective: To evaluate gender-based disparities in clinical outcomes, healthcare resource utilization, and hospitalization patterns among patients with SCD in the United States. Methods: We conducted a retrospective cohort analysis using a nationally representative inpatient database from 2016 to 2022. Adult patients hospitalized with a principal or secondary diagnosis of SCD were identified. Demographic characteristics, comorbid conditions, in-hospital outcomes (mortality, length of stay, complications), and healthcare utilization (inflation adjusted costs, and emergency procedures) were compared between male and female patients using multivariable regression models. Results: A total of 254,801 unweighted and 1,274,005 weighted hospitalizations for SCD were analyzed. Females accounted for approximately 63% of the cohort and 89% are African Americans. About 54.5% of these index admissions were due to sickle cell crisis. Females had higher proportion of Hispanics, while males were more likely to be African Americans. Mean age of the study cohort was 31.55 +-16.65 years and was higher in females (30 vs 32.5 years, P<0.001), while patients with sickle cell crisis are relatively younger (29 vs 34.5 years, P<0.001). Females had higher rates of elective admissions (16 vs 6%), requiring home health (4.6 vs 6.1%), Demographically, West region had slightly higher male patients with SCD admissions and South region have more female patients presenting with SCD. Also, males were more likely to be admitted in urban-teaching hospitals as well as non-metropolitan areas. Sickle cell crises was highly prevalent in African Americans (P<0.001), South region (P<0.001), and urban non-teaching hospitals (P<0.001). Compared to males, females had higher rates of anemic episodes, diabetes and depression (P<0.001), while males demonstrated a higher incidence of sickle crisis [OR: 2.29 (2.25-2.33)] and renal complications [OR: 1.47 (1.42-1.53)]. In-hospital mortality was significantly higher in male patients (0.7% vs. 0.5%, P<0.001), as was the need for stroke care (0.9 vs 0.7%) and blood transfusions (17.9 vs 15.3%), P<0.001. Males also had higher incidence of systolic heart failure and cardiac arrhythmias. Despite higher length of stay (4.85 vs 5.33 days), patients with sickle cell crisis had substantially lower hospitalization costs (14159 vs 11553$), P<0.001. Conversely, males had longer hospital stays and higher inflation-adjusted hospital costs over the study duration. which are not influenced by the presence of crisis on multiple linear regression analysis. Gender differences in healthcare utilization remained significant after adjusting for confounders. Conclusion: Our findings highlight substantial gender disparities in the clinical manifestations and outcomes of sickle cell disease. Male patients are at higher risk for life-threatening complications and in-hospital mortality, whereas female patients experience a greater burden of chronic symptoms. These insights underscore the need for gender-sensitive approaches in the management and support of patients with SCD.