Patients with sickle cell disease (SCD) and sickle cell trait (SCT) have significantly higher rates of hospitalization, pneumonia, and pain related to COVID-19 compared with Black patients with COVID-19 but without SCD/SCT, according to a study published in Blood Advances.
“Our findings imply that SCD is attributable to worse COVID-19 outcomes,” said lead investigator Ashima Singh, PhD, of the Medical College of Wisconsin, “and individuals with SCD should be considered high risk and be given access to high-quality care.”
Black individuals in the U.S. have been disproportionately affected by the COVID-19 pandemic and previous reports have documented higher rates of morbidity and mortality in communities of color. People with co-existing metabolic conditions, such as diabetes and hypertension, are also at higher risk of poor COVID-19 outcomes.
Few research studies to date have examined the impact of SCD/SCT on COVID-19 outcomes in Black patients. To gauge this impact, the study authors compared COVID-19–related outcomes in Black patients with COVID-19 and SCD (n=312) or SCT (n=449) versus Black patients with COVID-19 but without SCD/SCT (n=45,517). Data from January 20 through September 20, 2020, were collected from electronic health records. White patients were excluded from the SCD/SCT and control cohorts.
The investigators used ICD-10 codes to identify COVID-19 manifestations, including cough/fever, pneumonia or acute chest syndrome, pain, shortness of breath or hypoxia, and venous thromboembolism (VTE), pulmonary embolism (PE), acute respiratory distress, or respiratory failure. Hospitalization and mortality rates were also examined.
A review of the medical record data revealed that patients with SCD/SCT had a greater number of comorbidities that made them more susceptible to poor outcomes from COVID-19, compared with patients who did not have a diagnosis of SCD or SCT. The TABLE shows the rate of COVID-19 outcomes for the three groups of patients.
Patients with COVID-19 who had SCD were significantly younger than those who had COVID-19 without SCD/SCT (p<0.001) and a lower proportion of these patients had diabetes (p=0.0065). However, a higher proportion of those with SCD had asthma, liver conditions, cerebral infarction, history of acute kidney failure or chronic kidney disease, PE, and VTE (p<0.001 for all).
Additionally, patients with SCT were significantly younger (p<0.001), but a higher proportion were overweight or obese and had asthma, hypertension, diabetes, liver disease, and PE that those without SCD/SCT.
In a propensity-score matched cohort, Black patients with COVID-19 and comorbid SCD had significantly higher risks of:
- hospitalization within 14 days (relative risk [RR] = 2.0; 95% CI 1.5-2.7; p<0.001)
- hospitalization within 30 days (RR=2.2; 95% CI 1.6-2.8; p<0.001)
- pneumonia (RR=2.4; 95% CI 1.6-3.4; p<0.001)
- pain (RR=3.4; 95% CI 2.5-4.8; p<0.001)
However, there was no difference between the cohorts in terms of case fatality rates associated with COVID-19 at 14 days.
According to Dr. Singh, additional research is needed to investigate the long-term impact of COVID-19 in patients with SCD/SCT. “Irrespective of sickle cell disease or trait status, there is a need to examine health equity across races not only specific to management of COVID-19 illness, but throughout one’s lifetime,” she said.
Limitations of this study included its retrospective nature and the reliance on ICD codes, which tend to be inaccurate, to identify patients.
Singh A, Brandow AM, Panepinto JA. COVID-19 in individuals with sickle cell disease/trait compared with other Black individuals. Blood Adv. 2021;5:1915-1921.