Young adults with sickle cell disease are more likely to experience severe disease and complications, necessitating increased acute health care utilization. The increased risk of morbidity and mortality coincides with the transition from pediatric to adult health care, emphasizing the importance of maintaining uninterrupted, comprehensive care all through their life. It is recommended that young adults with chronic health diseases should be shifted to adult care within 6 months of leaving pediatric care. But usually there are transfer gaps leading to increased utilization of emergency care.

Kristen E Howell from the Dept. of Epidemiology and Biostatistics, Texas A&M University, Texas and colleagues from across the United States evaluated the association between different transfer gaps and the rates of inpatient, emergency department (ED), and outpatient visits using negative binomial regression in  patients with sickle cell disease. Health care utilization was analyzed within a mid-south comprehensive program over a follow-up period of up to 8 years (2012-2020), focusing specifically on the first 2 years of adult health care. Their objective was to find out if longer transfer gaps were associated with increased utilization of resources. They defined transfer gaps as the period between the last pediatric visit and the first adult visit.

A total of 183 young adults with sickle cell disease who had been shifted to adult health care between 2012 and 2018 were selected for the study; 51% of the study population was male and 67% had Hemoglobin SS (HbSS) and hemoglobin Sβ0-thalassemia (HbSβ0), which are both types of sickle cell disease.

Young adults with transfer gaps of 6 months or longer had a hospitalization rate that was 2.01 times higher compared to those with transfer gaps of less than 2 months during the 8-year follow-up period. When focusing specifically on the first 2 years of adult health care, the rate of hospitalization was 1.89 times higher for those with longer transfer gaps. During the first 2 years of adult care, the rate of ED visits was increased 1.75 times among those with transfer gaps ≥6 months compared with <2 months. Participants with transfer gaps of ≥2 to <6 months had 0.71 times the rate of outpatient visits versus those with transfer gaps of less than 2 months.

In conclusion, this study confirms that transfer gaps of less than 6 months can effectively reduce acute health care utilization for sickle cell disease. A longer transfer gap was associated with increased hospitalizations as well as a higher rate of emergency care during the first 2 years of adult care.

These findings therefore have important implications for policymakers, highlighting the need to address the challenges associated with the transition from pediatric to adult health care and to develop strategies that minimize transfer gaps and ensure continuous, comprehensive care for young adults with sickle cell disease.

Reference

1. Kristen E Howell, et al. Gaps during pediatric to adult care transfer escalate acute resource utilization in sickle cell disease. Blood Adv. 2024 Jul 23;8(14):3679-3685. doi: 10.1182/bloodadvances.2023011268.