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Journal Article Research Support, Non-U.S. Gov't Epublish 6 citations

PubMed: 34610933 DOI: 10.1136/bmjopen-2020-048407

Time trends, sociodemographic and health factors associated with discharge and length of stay of hospitalised patients with sickle cell disease in Ghana: a retrospective analysis of national routine health database.

BMJ Open 11(10):e048407

Authors: Clement Tetteh Narh, Joyce Der, Anthony Ofosu, Maria Blettner, Daniel Wollschlaeger

Affiliations

  • Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana.
  • Biostatistics, Johannes-Gutenberg Universitat Mainz Institut für Medizinische Biometrie Epidemiologie und Informatik, Mainz, Rheinland-Pfalz, Germany.
  • Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana.
  • Policy, Planning, Monitoring and Evaluation Division (PPMED), Ghana Health Service, Accra, Greater Accra, Ghana.
  • Radiation Epidemiology, Johannes-Gutenberg Universitat Mainz Institut für Medizinische Biometrie Epidemiologie und Informatik, Mainz, Rheinland-Pfalz, Germany.

Abstract

OBJECTIVE

Patients with sickle cell disease (SCD) are prone to multiple episodes resulting in frequent hospital visits. We determined the time trends, sociodemographic and health factors associated with length of stay (LoS) for patients with SCD in Ghana.

DESIGN, PARTICIPANTS, SETTING

We retrospectively analysed SCD hospitalisation records of 22 680 patients from a nationwide database of the Ghana Health Service from 2012 to 2017.

OUTCOME MEASURES

Factors associated with LoS were estimated using Cox regression, while the cumulative incidence of being discharged alive was estimated with in-hospital death as a competing risk.

RESULTS

Patients admitted for SCD over 6 years constituted 22 680 (0.8%) of nearly 3 million admissions. The median age and LoS for the patients were 16 years (IQR=8-24) and 3 days (IQR=2-4), representing 14 202 (62.6%) of the patients discharged alive by the third day. Patients with sickle cell anaemia (6139, 52.6%) with a crisis were more frequent than those without a crisis. Increasing age was associated with shorter LoS when comparing age groups 10-14 years (HR=1.08, 95% CI 1.01 to 1.14) and 25-29 years (HR=1.27, 95% CI 1.17 to 1.37) to patients aged 0-4 years. Patients with comorbidities had a longer LoS compared with those without (HR=0.88, 95% CI 0.86 to 0.90).

CONCLUSION

This is the largest study to date documenting factors associated with LoS for patients admitted for SCD. The association of younger age with increased LoS supports recent calls for early SCD screening, especially newborns. The emerging trends and factors accounting for SCD admission require a multisector approach as these patients already experience frequent episodes of pain and hospital visits.

MeSH

Length Of Stay, Epidemiology, Anemia, Sickle Cell, Public Health, Cells

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