Higher hydroxyurea adherence among young adults with sickle cell disease compared to children and adolescents. (31st December 2022)

• Record Type: Journal Article
• Authors: Reddy, Paavani S.; Cai, Stephanie W.; Barrera, Leonardo; King, Kathryn; Badawy, Sherif M.
• Is Part Of: Annals of medicine. Volume 54:Number 1(2022)
• Page Start: 683
• Page End: 693
• Publication Date: 2022-12-31
• Subjects: Sickle cell -- adherence -- compliance -- hydroxyurea -- hydroxycarbamide -- chronic pain -- health care utilization -- AYA -- adolescents and young adults -- haemoglobinopathy; Medicine -- Periodicals; 610
• DOI: 10.1080/07853890.2022.2044509
• Languages: English
• ISSNs: 0785-3890

Abstract

Abstract: Background: Sickle cell disease (SCD) results in severe complications, such as anaemia and pain episodes. Hydroxyurea (HU) is efficacious in SCD, yet adherence remains low. Objective: To assess the relationship of HU adherence to health care utilization and patients' characteristics. Methods: This is a 5-year retrospective chart review. Patients' demographics and medical history were collected from the electronic medical record (EMR). HU adherence was evaluated using foetal haemoglobin "HbF%", mean corpuscular volume "MCV", and absolute neutrophil count "ANC". Age groups included children (<12 years), adolescents (12–17 years), and young adults (≥18 years). Results: A total of 113 SCD patients on HU were included (median age 14 years, IQR 10–20; 50% female; 88% HbSS). Young adults had significantly higher HU adherence compared to adolescents and children, including higher median HbF% (24.2 vs . 12.4 vs . 8.6, p = .003), MCV (fl) (106.4 vs . 96.2 vs . 95.4, p = .01) and lower ANC (10 3 /ml) (3.25 vs . 4.9 vs . 4.2, p = .01), respectively. Patients with chronic pain had lower HU adherence (HbF% 15.3 vs . 10.7, p = .04; ANC 3.6 vs . 6.3, p = .002; MCV 102.3 vs . 93.1, p = .1). Patients with higher HbF or MCV and lower ANC had significantly less frequent emergency room visits (rs =–0.26, p = .01; rs =–0.23, p = .01; rs =0.24, p = .01) and hospitalizations (rs =–0.27, p = .01; rs =–0.31, p = .01; rs =0.21, p = .02) as well as shorter length of stays (rs =–0.27, p = .0045; rs =–.34, p = 0.004; rs =0.23, p = .02), respectively. Similar trends in HU adherence and health care utilization were seen in subgroup analysis of only HbSS patients. There was no significant association of HU adherence to patients' sex, socio-economic status, distance from hospital, and HU duration. Conclusions: Young adults with SCD had significantly higher HU adherence compared to children and adolescents. Patients with lower HU adherence and/or chronic pain had increased health care utilization. Future studies examining barriers to adherence and evaluating interventions to optimize HU adherence in SCD are warranted. KEY MESSAGES: Young adults with SCD had significantly higher HU adherence, as reflected in their laboratory markers, compared to children and adolescents. Patients with higher HU adherence and/or those without chronic pain had lower or less frequent health care utilization. No significant association of HU adherence to patients' sex, socio-economic status and distance from hospital.