Variations in Health Services Use among Children in Michigan with Sickle Cell Trait

Background
Sickle cell disease (SCD) is a chronic disease affecting predominately minority populations. Numerous subtypes of SCD, particularly sickle cell anemia (HbSS), are associated with significant morbidity and mortality. The negative health effects of sickle cell anemia are well known; it is associated with complications such as pain crises and increased risks of stroke and infection. Until recently, the carrier status of sickle cell trait has generally been considered a relatively benign condition.  However, there are a growing number of reports indicating that potentially serious complications of sickle cell trait may exist, including cancer and splenic issues. To date, there have been no large-scale cohort studies performed among individuals with sickle cell trait, limiting the ability to identify complications pertaining to this condition. Additionally, virtually nothing is known regarding health services use among this potentially vulnerable population. 

Specific aims for this project are as follows:

  • Aim 1: Identify the population of individuals born with sickle cell trait in the state of Michigan. 
  • Aim 2: Characterize the health services utilization of children with sickle cell trait enrolled in Michigan Medicaid. 
  • Aim 3: Evaluate potentially serious health complications associated with sickle cell trait.

Methods
One promising approach to identify potential serious health effects of sickle cell trait relies on administrative claims. Administrative claims methods have been successfully used for other chronic disease conditions and are widely used in health care quality assessments and outcomes research. However, the vast majority of children with sickle cell trait cannot be identified through the use of claims, as these children are not making contact with the health system for issues that are coded as being related to trait.  A unique opportunity to identify cases of sickle cell trait and identify potential health effects exists in Michigan, as Michigan is one of the only states with linkage of NBS records to Medicaid data. We will use this rich dataset to identify potential health complications related to sickle cell trait from administrative data and NBS records; our approach will be implemented in 3 phases:

  • Phase 1: Identify the population of individuals with sickle cell trait. We will identify children born in the state of Michigan with sickle cell trait through newborn screening records to serve as the basis for investigating health risks associated with sickle cell trait.
  • Phase 2: Characterize the health services utilization. Using Michigan Medicaid administrative claims, we will profile the healthcare utilization of children with sickle cell trait compared to children with sickle cell anemia and children with normal hemoglobin.
  • Phase 3: Evaluate potentially serious health complications associated with sickle cell trait. We will also use Michigan Medicaid administrative claims to identify previously unknown potential complications that may be associated with sickle cell trait as compared to children with sickle cell anemia and children with normal hemoglobin, particularly while accounting for differences in receipt of preventive care.

Implications
The successful investigation of these three aims will establish the degree to which excess healthcare utilization and serious health complications are associated with sickle cell trait. Timely investigation of these issues will address growing concerns that sickle cell trait may pose more of a health risk than previously considered. The CDC has recently identified understanding the potential health effects of sickle cell trait as of both vital importance and tremendous challenge. The public health implications of this research are significant, as sickle cell trait will continue to become increasingly prevalent in the context of changing US demographics.

Funded by the Blue Cross Blue Shield Michigan Foundation

For more information, please contact:
Investigator: Sarah L. Reeves, PhD, MPH
University of Michigan Child Health Evaluation and Research (CHEAR) Center
300 North Ingalls, 6D19
Ann Arbor, MI 48109-5456
Telephone: (734) 615-8319 Fax: (734) 764-2599 Email: sleasure[at]umich[dot]edu