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Avelino NDDS, Konstantyner T, Areco KCN, Franco JM, Braga JAP. Mortality trends and sociodemographic factors associated with early death in sickle cell disease patients in the state of São Paulo. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2024; 42:e2023113. [PMID: 38808868 PMCID: PMC11135900 DOI: 10.1590/1984-0462/2024/42/2023113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 02/18/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE To estimate trends in mortality rate and average age of death, and identify sociodemographic factors associated with early death in patients with sickle cell disease (SCD). METHODS An ecological and cross-sectional study was conducted using data from the Mortality Information System. All deaths of patients residing in the state of São Paulo from 1996 to 2015 with at least one International Disease Code for SCD in any field of the death certificate were included. Simple linear regression was used to estimate trends. The Log-rank test and multiple Cox regression were used to identify factors associated with early death. RESULTS The age-standardized mortality rate per million inhabitants increased by 0.080 per year (R2=0.761; p<0.001). When the events were stratified by age at death, the increase was 0.108 per year for those occurring at age 20 years or older, (R2=0.789; p<0.001) and 0.023 per year for those occurring before age 20 years old (R2=0.188; p=0.056). The average age at death increased by 0.617 years (7.4 months) per year (R2=0.835; p<0.001). Sociodemographic factors associated with early death identified were male gender (hazard ratio - HR=1.30), white race (HR=1.16), death occurring in the hospital (HR=1.29), and living in the Greater São Paulo (HR=1.13). CONCLUSIONS The mortality rate and the average age of death in patients with SCD have increased over the last two decades. Sociodemographic factors such as gender, race, place of occurrence, and residence were found to be associated with early death.
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Affiliation(s)
| | - Tulio Konstantyner
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
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Santo AH. Mortality related to sickle cell disease and COVID-19 in Brazil, 2020. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231466. [PMID: 38747879 PMCID: PMC11095967 DOI: 10.1590/1806-9282.20231466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/28/2023] [Indexed: 05/18/2024]
Abstract
OBJECTIVE The ability to cause death is the definitive measure of an infectious disease severity, particularly one caused by a novel pathogen like severe acute respiratory syndrome-CoV-2 (COVID-19). This study describes sickle cell disease-related mortality issues during the COVID-19 pandemic in Brazil. METHODS The provisional 2020 mortality data originated from the public databases of the Mortality Information System and were investigated using the multiple-cause-of-death methodology. RESULTS In 2020, 688 sickle cell disease-related deaths occurred, of which 422 (61.3%) had an underlying cause of death and 266 (38.7%) had an associated cause of death. Furthermore, 98 COVID-19-related deaths occurred, of which 78 were underlying cause of death among sickle cell disease associated (non-underlying) cause of death. Sickle cell disease-related deaths occurred mostly among young adults aged 25-49 years. COVID-19 deaths occurred at ages older than among sickle cell disease-related deaths. Majority of deaths happened in the southeast (42.3%) and northeast regions (34.0%), while COVID-19 deaths prevailed in the northeast region (42.9%). Regarding overall deaths, the leading underlying cause of death was sickle cell disease itself, followed by infectious and parasitic diseases (14.8%), owing to COVID-19 deaths, and diseases of the circulatory system (8.9%). Next, in males, diseases of the digestive system (4.8%) occurred, while, in females, maternal deaths succeeded, included in the chapter on pregnancy, childbirth, and the puerperium, accounting for 5.9% of female deaths. The leading overall associated (non-underlying) cause of deaths were septicemias (29.4%), followed by respiratory failure (20.9%), pneumonias (18.3%), and renal failure (14.7%). CONCLUSION In Brazil, COVID-19 deaths produced trend changes in sickle cell disease-related causes of death, age at death, and regional distribution of deaths in 2020.
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Affiliation(s)
- Augusto Hasiak Santo
- Universidade de São Paulo (retired), Faculty of Public Health, Department of Epidemiology – São Paulo (SP), Brazil
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3
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Alkindi S, Al-Jadidi S, Al-Adawi S, Elsadek RA, Al Madhani A, Al-Nabhani M, Pathare AV. Multi-center study on mortality in children, and adults with sickle cell anemia-risk factors and causes of death. Sci Rep 2024; 14:8584. [PMID: 38615021 PMCID: PMC11016086 DOI: 10.1038/s41598-024-58328-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/27/2024] [Indexed: 04/15/2024] Open
Abstract
Sickle cell disease (SCD) is a major public health burden worldwide with increasing morbidity and mortality. The study evaluates the risk factors associated with mortality in SCD patients, between the years 2006 and 2020 at three hospitals in Oman. The analysis includes clinical manifestations, haematological, biochemical, and radiological parameters, use of antibiotics, and blood and exchange transfusions. Our cohort included 123 patients (82 males, 41 females), with a median age of 27 (Interquartile Range 21-35 years). SCD related complications included acute chest syndrome (ACS) in 52.8%, splenic sequestration in 21.1%, right upper quadrant syndrome in 19.5%, more than > 6 VOC/year in 17.9%, and stroke in 13.8%. At the terminal admission, patients had cough, reduced O2 saturation, crepitation and fever in 24.4%, 49.6%, 53.6% and 68.3% respectively. Abnormal chest X-ray and chest CT scan were seen in 57.7%, and 76.4% respectively. Laboratory parameters showed a significant drop in hemoglobin (Hb) and platelet counts from baseline, with a significant rise in WBC, LDH and CRP from baseline (p < 0.05, Wilcoxon Signed Ranks test). All patients received antibiotics, whereas, 95.9% and 93.5% received simple blood transfusions, and exchange transfusions respectively, and 66.6% required non-invasive ventilation. Among the causes of death, ACS is seen in 32 (26%), sepsis in 49 (40%), and miscellaneous in 42 (34%). Sudden death was seen in 32 (26%) of patients. Male gender, with low HbF, rapid drop in Hb and platelet, and increased in WBC, LDH, ferritin, and CRP, correlated significantly with mortality in this cohort.
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Affiliation(s)
- Salam Alkindi
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, P. O. Box 35, 123, Muscat, Oman.
| | - Salma Al-Jadidi
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, P. O. Box 35, 123, Muscat, Oman
| | - Safa Al-Adawi
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, P. O. Box 35, 123, Muscat, Oman
| | | | | | | | - Anil V Pathare
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, P. O. Box 35, 123, Muscat, Oman
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Figueira CO, Guida JPS, Surita FG, Antolini-Tavares A, Saad ST, Costa FF, Fertrin KY, Costa ML. Sickle cell disease and increased adverse maternal and perinatal outcomes in different genotypes. Hematol Transfus Cell Ther 2024:S2531-1379(24)00056-7. [PMID: 38494406 DOI: 10.1016/j.htct.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/23/2023] [Accepted: 02/12/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Sickle cell disease (SCD) comprises a heterogeneous group of inherited hemolytic disorders that increases the risk of maternal and perinatal complications due to chronic systemic inflammatory response, endothelial damage and vaso-occlusion. The contribution of genotypes to the severity of outcomes during pregnancy is not completely established. METHODS A retrospective study of medical charts was performed to compare maternal and perinatal outcomes in Hb SS, Hb SC disease and sickle-beta thalassemia (Hb Sβ) pregnancies followed at a high-risk antenatal care unit over a 6-year period. A descriptive analysis of morphological findings was performed of the placenta when pathology reports were available. RESULTS Sixty-two SCD pregnant women [25 Hb SS (40 %), 29 Hb SC (47 %) and 8 Hb Sβ (13 %)] were included. Overall, SCD was associated with maternal complications (77 %), preterm birth (30 %), cesarean section (80 %) and a need of blood transfusion. In general there were no statistically significant differences between genotypes. The only significant difference was the hemoglobin level at first antenatal care visit which was lower for the homozygous genotype (7.7 g/dL) compared to Hb SC and Hb Sβ (9.7 g/dL and 8.4 g/dL, respectively; p-value = 0.01). Ten of 15 evaluated placentas showed abnormal morphological findings CONCLUSION: SCD, regardless of the underlying genotype, is associated with increased adverse maternal and perinatal outcomes and placental abnormalities associated with maternal vascular malperfusion.
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Affiliation(s)
- Camilla Olivares Figueira
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil
| | - José Paulo S Guida
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil
| | - Fernanda G Surita
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil
| | - Arthur Antolini-Tavares
- Department of Pathological Anatomy, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo St, Campinas, São Paulo 13083-887, Brazil
| | - Sara T Saad
- Department of Hematology and Hemotherapy, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo St, Campinas, São Paulo 13083-887, Brazil
| | - Fernando F Costa
- Department of Hematology and Hemotherapy, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo St, Campinas, São Paulo 13083-887, Brazil
| | - Kleber Y Fertrin
- Division of Hematology, Department of Medicine, University of Washington, WA 98195, Seattle, WA, USA
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil.
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Moura Neto JP, Albuquerque CCMX, Yahouedehou SCMA, Francisco MVL, Fraiji NA, de Siqueira IC, Gonçalves MS. Prevalence of arboviruses in sickle cell disease patients from two different regions of Brazil, the North and Northeast. Braz J Infect Dis 2024; 28:103741. [PMID: 38670165 PMCID: PMC11070587 DOI: 10.1016/j.bjid.2024.103741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/29/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Sickle Cell Disease (SCD) is a hereditary disease characterized by extravascular and intravascular hemolysis and clinical variability, from mild pain to potentially life-threatening. Arboviruses include mainly Zika (ZIKV), Chikungunya (CHKV), and Dengue (DENV) virus, and are considered a public and social health problem. The present cross-sectional observational study aimed to investigate the prevalence of arbovirus infection in SCD patients from two Brazilian cities, Salvador and Manaus located in Bahia and Amazonas states respectively. A total of 409 individuals with SCD were included in the study, and 307 (75.06 %) patients tested positive for DENV-IgG, 161 (39.36 %) for ZIKV-IgG, and 60 (14.67 %) for CHIKV-IgG. Only one individual was positive for DENV-NS1 and another for DENV-IgM, both from Salvador. No individuals had positive serology for ZIKV-IgM or CHIKV-IgM. Arbovirus positivity by IgG testing revealed that the SCD group presented high frequencies in both cities. Interestingly, these differences were only statistically significant for ZIKV-IgG (p = 0.023) and CHIKV-IgG (p = 0.005) among SCD patients from Manaus. The reshaping of arbovirus from its natural habitat by humans due to disorderly urban expansion and the ease of international Mobility has been responsible for facilitating the spread of vector-borne infectious diseases in humans. We found the need for further studies on arboviruses in this population to elucidate the real association and impact, especially in acute infection. We hope that this study will contribute to improvements in the personalized clinical follow-up of SCD patients, identifying the influence of arbovirus infection in severe disease manifestations.
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Affiliation(s)
- José Pereira Moura Neto
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Gonçalo Moniz, Salvador, BA, Brazil; Faculdade de Ciências Farmacêuticas, Laboratório de Análise Especializada em Biologia Molecular (LAEBM), Universidade Federal do Amazonas, Manaus, AM, Brazil; Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil.
| | | | | | | | - Nelson Abrahim Fraiji
- Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
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Cansian B, Faria JCP, Sarni ROS. Transfusion of packed red blood cells in adults with sickle cell anemia treated at an emergency hospital. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20230816. [PMID: 38422317 PMCID: PMC10903271 DOI: 10.1590/1806-9282.20230816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The aim of this study was to analyze the prescription of packed red blood cells performed by emergency physicians for adults with sickle cell anemia. METHODS Transfusions performed in adults with sickle cell anemia treated at an emergency service in São Bernardo do Campo, São Paulo Brazil, between January 2018 and January 2022 were evaluated. For data comparison, the chi-square2 test was used. The significance level adopted was 5%. RESULTS A total of 114 transfusions were performed. The mean age was 41.8±16.4 years, and pretransfusion hemoglobin was 6.1±1.23 g/dL. Regarding the indication, the adequacy of transfusions performed in symptomatic individuals was significantly higher compared to asymptomatic individuals (100% vs. 3.9%, p<0.001). Symptomatic individuals received excessive volumes of packed red blood cells less frequently than asymptomatic individuals (17.5% vs. 56.9%, p<0.001). The filtered subtype, indicated for sickle cell anemia, was prescribed in only a quarter of the patients. However, non-indicated subtypes were frequently prescribed. CONCLUSION This study found low adequacy in the indication and calculation of the transfusion volume of packed red blood cells in asymptomatic individuals. Few patients received filtered red blood cells, resulting in increased risks of transfusion reactions. On the contrary, non-indicated subtypes were prescribed in a quarter of transfusions, which resulted in higher costs and delay in receiving packed red blood cells.
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Affiliation(s)
- Bianca Cansian
- ABC Faculty of Medicine, University Center - Santo André (SP), Brazil
| | - João Carlos Pina Faria
- ABC Faculty of Medicine, University Center - Santo André (SP), Brazil
- Universidade Municipal de São Caetano do Sul, Universidade Nove de Julho, ABC Faculty of Medicine, University Center - São Caetano do Sul (SP), Brazil
| | - Roseli Oselka Saccardo Sarni
- ABC Faculty of Medicine, University Center - Santo André (SP), Brazil
- Universidade Federal de São Paulo, ABC Faculty of Medicine, University Center - São Paulo (SP), Brazil
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7
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de Oliveira Taques W, Bett GC, de Moraes BLB, Medeiros I, Fontes CJF, Godinho de Oliveira R. Factors Associated with Overt Stroke in Children and Adolescents with Sickle Cell Disease: A Retrospective Cohort Study. Hemoglobin 2024; 48:39-46. [PMID: 38263710 DOI: 10.1080/03630269.2023.2301490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024]
Abstract
Sickle cell disease (SCD) is associated with a high occurrence of complications due to vaso-occlusive phenomenon such as stroke. This retrospective cohort study aimed to examine the clinical and laboratory characteristics of 120 children and adolescents with SCD and analyze the factors associated with overt stroke incidence. All relevant data were obtained from patient medical records. Survival analysis was used to compare the demographic, clinical, and laboratory characteristics between patients with and those without overt stroke. The patients were 52.5% female with a mean (SD) age of 11.2 (4.3) years. The incidence of overt stroke in this cohort was nine out of 956.7 patient-years, resulting in an incidence density of 0.94 cases/100 patient-years. Reports of greater than or equal to two previous attacks of dactylitis and greater than or equal to three episodes of acute chest syndrome (ACS)/pneumonia were associated with overt stroke and an increase in reticulocyte count and red blood cell distribution width (RDW). In conclusion, a history of a high number of dactylitis, ACS/pneumonia, increased RDW, and reticulocytosis was associated with overt stroke occurrence in children and adolescents with SCD. Future studies with a higher stroke incidence in the evaluated sample are necessary to confirm this hypothesis.
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Affiliation(s)
- Wolney de Oliveira Taques
- Júlio Müller University Hospital/EBSERH, Teaching and Research Management, Federal University of Mato Grosso - UFMT, Cuiabá, Brazil
- Medicine Course, Várzea Grande University Center (UNIVAG), Várzea Grande, Brazil
- Hematology Outpatient Clinic of MT-Hemocentro, State Health Department of MT - Mato Grosso, Cuiabá, Brazil
| | - Gabriele Curvo Bett
- Medicine Course, Várzea Grande University Center (UNIVAG), Várzea Grande, Brazil
| | | | - Iasmin Medeiros
- Medicine Course, Várzea Grande University Center (UNIVAG), Várzea Grande, Brazil
| | - Cor Jesus Fernandes Fontes
- Júlio Müller University Hospital/EBSERH, Teaching and Research Management, Federal University of Mato Grosso - UFMT, Cuiabá, Brazil
- Medicine Course, Várzea Grande University Center (UNIVAG), Várzea Grande, Brazil
| | - Ruberlei Godinho de Oliveira
- Júlio Müller University Hospital/EBSERH, Teaching and Research Management, Federal University of Mato Grosso - UFMT, Cuiabá, Brazil
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Santos RL, Rodrigues W, Prata D, Trevisan DMDQ, Bermejo PHDS, Moreira MF. Covid-19 impacts: Ethnic and regional inequalities in sickle cell disease patient care in Brazil. Heliyon 2023; 9:e21960. [PMID: 38058620 PMCID: PMC10695839 DOI: 10.1016/j.heliyon.2023.e21960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 10/23/2023] [Accepted: 11/01/2023] [Indexed: 12/08/2023] Open
Abstract
Brazil is a continental country with significant socioeconomic and ethnic inequalities. It is important to understand how these differences are reflected in health care, especially during the COVID-19 pandemic. We investigated the potential impacts of the reduced number Transcranial Doppler Ultrasound (TCD) tests performed in Brazil during the COVID-19 pandemic, and its reflections according to region and race/color for patients with Sickle Cell Disease (SCD). This study performed data queries from the Brazilian Ministry of Health, literature research, and quantitative analysis using descriptive statistical analysis. We found evidence for a decrease in the number of TCD tests performed during the pandemic (-83 %) relative to the same non-pandemic period, and disparities in tests given in five regions in Brazil. Our data show, that in absolute numbers, most people with SCD are brown, but the highest prevalence of cases was among blacks. We also found evidence for racial discrimination when performing TCD test, which leads us to believe that the Brazilian Unified Health System (SUS) may be susceptible to racism when treating this disease. The implications of these findings serve as a warning to other countries with high indices of mixed ancestry in formulating health care policies for patients with SCD.
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Affiliation(s)
- Rui Leandro Santos
- Program of Computational Modelling, Federal University of Tocantins. Palmas, TO, Brazil
| | - Waldecy Rodrigues
- Program of Computational Modelling, Federal University of Tocantins. Palmas, TO, Brazil
| | - David Prata
- Program of Computational Modelling, Federal University of Tocantins. Palmas, TO, Brazil
| | | | | | - Marina Figueiredo Moreira
- School of Economics, Business Administration, Accounting and Information Science, University of Brasilia, Brazil
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Cordovil K, Tassinari W, Oliveira RDVCD, Hökerberg Y. Social inequalities in the temporal trend of mortality from sickle cell disease in Brazil, 1996-2019. CAD SAUDE PUBLICA 2023; 39:e00256421. [PMID: 36651378 DOI: 10.1590/0102-311xen256421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 10/27/2022] [Indexed: 01/18/2023] Open
Abstract
Contrary to international trends, the mortality rate of sickle cell disease increased in Brazil after the implementation of the neonatal screening program, probably due to improving access to diagnosis. This study aimed to assess differences in the temporal trend of the mortality rate and median age at death from sickle cell disease in Brazil, considering implemented measures to expand diagnosis, and improve health care access in-country and in the international scenario. Time series were extracted from the Brazilian Mortality Information System from 1996 to 2019. Changes in the mortality rate and median age at death were verified via segmented regression models, which were stratified by sex, region of residence, and age. Most deaths occurred in non-white people, young adults, and the Southeast and Northeast population. Sickle cell disease mortality rate increased until 2010 (13.31%; 95%CI: 6.37; 20.70), particularly in individuals aged 30 years or more (12.78%; 95%CI: 2.98; 23.53) and in the Northeast (12.27%; 95%CI: 8.92; 15.72). Most deaths occurred in the second decade of life (3.01 deaths/million), with a 59% increase in the median age of death in Brazil, from 27.6 to 30.3 years, more pronounced in females and the North Region. The observed gain in the survival of sickle cell disease in Brazil is still much lower than in developed countries and presents regional disparities, probably due to the lack of access to health care and recent treatments, such as hydroxyurea, still restricted to hematological referral centers in Brazilian capitals.
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Affiliation(s)
- Karen Cordovil
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Wagner Tassinari
- Instituto de Ciências Exatas, Universidade Federal Rural do Rio de Janeiro, Seropédica, Brasil
| | | | - Yara Hökerberg
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Sickle Cell Disease in Bahia, Brazil: The Social Production of Health Policies and Institutional Neglect. SOCIETIES 2022. [DOI: 10.3390/soc12040108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A disease is considered neglected when it is not given due priority in health policies despite the social relevance of that disease, either in terms of the number of individuals affected by it or its morbidity or mortality. Although the causes are structural, neglect in health does not occur in a vacuum. In this paper, we explore how sickle cell disease (SCD) is constructed and neglected in Brazil, based on insights from our long-term participatory qualitative research in the state of Bahia. We present five overarching themes relevant to the social production of SCD, and associated health policies in Brazil: (1) The achievements and setbacks to overcome neglect in SCD, (2) Continuity of comprehensive SCD care; (3) Social movements of people with SCD; (4) Biocultural citizenship; and (5) Academic advocacy. We conclude that it is insufficient to merely recognize the health inequities that differentiate white and black populations in Brazil; racism must be understood as both a producer and a reproducer of this process of neglect. We conclude with a set of recommendations for the main SCD stakeholder groups committed to improving the lives of people living with SCD.
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Phenotypes of sickle cell intensive care admissions: an unsupervised machine learning approach in a single-center retrospective cohort. Ann Hematol 2022; 101:1951-1957. [PMID: 35836008 DOI: 10.1007/s00277-022-04918-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/27/2022] [Indexed: 11/01/2022]
Abstract
Sickle cell disease (SCD) is associated with multiple known complications and increased mortality. This study aims to further understand the profile of intensive care unit (ICU) admissions of SCD patients. In this single-center retrospective cohort (approval number 0926-11), we evaluated SCD-related ICU admissions at our hospital in São Paulo, Brazil. Admissions were clustered using clinical data and organ dysfunction at ICU admission. A hierarchical clustering method was used to distinguish phenotypes. From 140 admissions obtained, 125 were included. The mean age was 30 years, 48% were male, and SS genotype was predominant (71.2%). Non-surgical causes of admissions accounted for 85.6% (n = 107). The mean Sequential Organ Failure Assessment score (SOFA) was 4 (IQR 2-7). Vasopressors were required by 12% and mechanical ventilation by 17.6%. After analysis of the average silhouette width, the optimal number of clusters was 3: cluster 1 (n = 69), cluster 2 (n = 25), cluster 3 (n = 31). Cluster 1 had a mean age of 29 years, 87% of SS genotype, and mean SOFA of 4. Cluster 2 had a mean age of 37 years, 80% of SS genotype, and mean SOFA of 8. Cluster 3 had a mean age of 26 years, 29% of SS genotype, and mean SOFA of 3. The need for mechanical ventilation was 11.6%, 44%, and 9.7%, respectively. Mortality was significantly higher in cluster 2 (44%, p = 0.012). This cohort of critical SCD admissions suggested the presence of three different profiles. This can be informative in the ICU setting to identify SCD patients at higher risk of worse outcomes.
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Nascimento MID, Przibilski ALF, Coelho CSG, Leite KFDA, Makenze M, Jesus SBD. Mortality attributed to sickle cell disease in children and adolescents in Brazil, 2000-2019. Rev Saude Publica 2022; 56:65. [PMID: 35792777 PMCID: PMC9239544 DOI: 10.11606/s1518-8787.2022056003681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/08/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Estimate rates and describe mortality trends attributed to sickle cell disease in children and adolescents in Brazil from 2000 to 2019. METHODS This is an ecological study of the time-trend of mortality rates that used the autoregressive method, proposed by Prais-Winsten, to evaluate trends in the estimated rates of sickle cell disease deaths in children and adolescents in Brazil. Deaths with code D57 were obtained from the Mortality Information System, considering age groups (0–4, 5–9, 10–14, 15–19 years) and were used to estimate age-specific and standardized rates by gender and age. RESULTS From 2000 to 2019, Brazil had 2,422 deaths from sickle cell disease in people under 20 years of age, with higher frequency in the Northeast (40.46%), followed by the Southeast (39.02%), Midwest (9.58%), North (7.84%), and South (3.10%). The main victims were people of Black skin/race (78.73%). In Brazil, the global standardized average rate was 0.20/100,000 people-year, with an elevation trend (annual percentage change – APC = 5.44%; confidence interval – 95%CI: 2.57–8.39). The pattern was repeated in males (APC = 4.38%; 95%CI: 2.17–6.64) and females (APC = 6.96%; 95%CI: 3.05–11.01). Elaborating age-specific rates showed that the range up to four years experienced the highest rates, without distinction by region. The age group of 15 and 19 years was the second most affected in Brazil and in the Northeast, Southeast, and Midwest regions. CONCLUSION Deaths due to sickle cell disorders showed an elevation trend in children and adolescents. Considering that the magnitude of deaths was more evident in the first years (0–4) and late adolescence (15–19), the study suggests that age-specific approaches may impact the control of fatal outcomes caused by sickle cell disease in Brazil.
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Affiliation(s)
- Maria Isabel do Nascimento
- Universidade Federal Fluminense. Faculdade de Medicina. Mestrado Profissional em Saúde Materno Infantil. Niterói, RJ, Brasil.,Universidade Federal Fluminense. Faculdade de Medicina. Programa de Iniciação Científica. Niterói, RJ, Brasil
| | | | | | | | - Mariana Makenze
- Universidade Federal Fluminense. Faculdade de Medicina. Programa de Iniciação Científica. Niterói, RJ, Brasil
| | - Stella Bayer de Jesus
- Universidade Federal Fluminense. Faculdade de Medicina. Programa de Iniciação Científica. Niterói, RJ, Brasil
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13
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Pompeo CM, Ferreira Júnior MA, Cardoso AIDQ, Souza MDC, Frota OP, Mota FM, Ivo ML. Clinical-Epidemiological Characteristics and Mortality in Patients with Sickle Cell Anemia: A Retrospective Cohort Study of 1980 at 2018. Int J Gen Med 2022; 15:1057-1074. [PMID: 35140508 PMCID: PMC8818769 DOI: 10.2147/ijgm.s342971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/07/2021] [Indexed: 01/09/2023] Open
Abstract
Purpose To analyze the clinical-epidemiological characteristics and mortality in patients with sickle-cell anemia (SCA). Patients and Methods A cohort study with retrospective data, conducted in two reference hospitals for SCA treatment from January 1980 to December 2018, recorded in two reference services. With a 5% significance level, the Chi-Square and Student’s t-tests were employed in the inferential statistical analysis. Results A total of 128 patients with SCA were studied. Diagnosis up to the fifth day of life was made in 10 patients. There were 19 deaths, of which 12 (63.2%) were female, and the average age at death was 27.05 (± 14.78) years. The leading causes of death were septic shock and cardiogenic shock. The use of invasive medical devices was considered a risk factor for death (RR=2.63; 95% CI=1.16–5.96; p=0.018), and monitoring time up to 20 years presented a 31% reduction in the risk of dying (RR=0.31; 95% CI=0.12–0.82; p=0.011) when compared to the monitoring of more than 20 years. Conclusion These findings are to be considered in the treatment of patients with SCA, mainly regarding early diagnosis and access to the treatment immediately afterward, since they are fundamental in improving survival and reducing severe complications.
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Affiliation(s)
- Carolina Mariano Pompeo
- Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- Correspondence: Carolina Mariano Pompeo, Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil, Tel +55 67 99984-7048, Email
| | | | | | - Mercy da Costa Souza
- Graduate Program in Health and Development in the Midwest Region, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Oleci Pereira Frota
- Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Felipe Machado Mota
- Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Maria Lúcia Ivo
- Graduate Program in Health and Development in the Midwest Region, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
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14
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Lobo C, Moura P, Fidlarczyk D, Duran J, Barbosa R, Oliveira T, do Nascimento EM, Bhakta N, Hankins JS. Cost analysis of acute care resource utilization among individuals with sickle cell disease in a middle-income country. BMC Health Serv Res 2022; 22:42. [PMID: 34998394 PMCID: PMC8742916 DOI: 10.1186/s12913-021-07461-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/28/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The costs associated with the treatment of sickle cell disease (SCD) are understudied in low and middle-income countries (LMIC). We evaluated the cost of treating SCD-related acute complications and the potential cost-savings of hydroxyurea in a specialized hematology center in Brazil. METHODS The costs (US dollars) of emergency department (ED) and hospitalizations from SCD-related complications between 01.01.2018 and 06.30.2018 were ascertained using absorption and micro-costing approaches. The reasons for acute hospital visits were grouped as: 1) vaso-occlusive (VOC) pain, 2) infection, 3) anemia exacerbation, and 4) chronic organ damage complications. Hydroxyurea adherence was estimated by medication possession ratio (MPR) during the study period. RESULTS In total, 1144 patients, median age 17 years (range 0-70), 903 (78.9%) with HbSS/HbSβ0-thalassemia, 441 (38.5%) prescribed hydroxyurea, visited the ED, of whom 381 (33%) were admitted. VOC accounted for 64% of all ED visits and 60% of all admissions. Anemia exacerbation was the most expensive reason for ED visit ($321.87/visit), while chronic organ damage carried the highest admission cost ($2176.40/visit). Compared with other genotypes, individuals with HbSS/HbSβ0-thalassemia were admitted more often (79% versus 21%, p < 0.0001), and their admission costs were higher ($1677.18 versus $1224.47/visit, p = 0.0001). Antibiotics and analgesics accounted for 43% and 42% of the total ED costs, respectively, while housing accounted for 46% of the total admission costs. Costs of ED visits not resulting in admissions were lower among HbSS/HbSβ0-thalassemia individuals with hydroxyurea MPR ≥65% compared with visits by patients with MPR <65% ($98.16/visit versus $182.46/visit, p = 0.0007). No difference in admission costs were observed relative to hydroxyurea use. DISCUSSION In a LMIC hematology-specialized center, VOCs accounted for most acute visits from patients with SCD, but costs were highest due to anemia exacerbation. Analgesics, antibiotics, and housing drove most expenses. Hydroxyurea may reduce ED costs among individuals with HbSS/HbSβ0-thalassemia but is dependent on adherence level.
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Affiliation(s)
- Clarisse Lobo
- Instituto Estadual de Hematologia do Rio de Janeiro HEMORIO, Rio de Janeiro, RJ, Brazil
| | - Patricia Moura
- Instituto Estadual de Hematologia do Rio de Janeiro HEMORIO, Rio de Janeiro, RJ, Brazil
| | - Delaine Fidlarczyk
- Instituto Estadual de Hematologia do Rio de Janeiro HEMORIO, Rio de Janeiro, RJ, Brazil
| | - Jane Duran
- Instituto Estadual de Hematologia do Rio de Janeiro HEMORIO, Rio de Janeiro, RJ, Brazil
| | - Roberto Barbosa
- Instituto Estadual de Hematologia do Rio de Janeiro HEMORIO, Rio de Janeiro, RJ, Brazil
| | - Thais Oliveira
- Instituto Estadual de Hematologia do Rio de Janeiro HEMORIO, Rio de Janeiro, RJ, Brazil
| | - Emilia Matos do Nascimento
- Instituto Estadual de Hematologia do Rio de Janeiro HEMORIO, Rio de Janeiro, RJ, Brazil
- Fundação Centro Universitário Estadual da Zona Oeste UEZO, Rio de Janeiro, Brazil
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, 262 Danny Thomas Place, TN, 38105, Memphis, USA
| | - Jane S Hankins
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, 262 Danny Thomas Place, TN, 38105, Memphis, USA.
- Department of Hematology, St. Jude Children's Research Hospital, TN, 38105, Memphis, USA.
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15
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Opioids are not a major cause of death of patients with sickle cell disease. Ann Hematol 2021; 100:1133-1138. [PMID: 33758998 DOI: 10.1007/s00277-021-04502-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
According to the Center of Disease Control and Prevention (CDC) database, the total number of deaths due to opioid overdose from 1999 through 2018 was 840,629. Given the alarming nature of these statistics, patients who requested prescription for opioids became targets of suspicion and possible accusation of maladaptive behavior. Patients with sickle cell disease (SCD) were often not exempt from such accusations and became guilty by association. In order to clarify the effect of opioids on the mortality of patients with SCD, the mortality rates for children and adults with SCD were investigated using the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death database which is based on all the death certificates issued in the USA from 1999 to 2018. The data showed that 15,765 patients with SCD died from 1999 to 2018. Only 348 patients with SCD died due to opioids. The CDC database contains 27 categories of death based on ICD-10 codes in patients with SCD, and opioids were the 19th ranking cause of death. Surprisingly the most common causes of death of patients with SCD included circulatory, infection, respiratory, genitourinary, and vaso-occlusive crises/acute chest syndrome disorders in decreasing frequency. The mean age of death of females was 41.9 years and of males 39.3 years (p < 0.0001). Death due to SCD and death due to SCD and opioids were highest in the Southern Region of the USA.
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16
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Camelo RM, Caram-Deelder C, Duarte BP, de Moura MCB, Costa NCDM, Costa IM, Roncal CGP, Vanderlei AM, Guimaraes TMR, Gouw S, Rezende SM, van der Bom J. Cardiovascular risk factors among adult patients with haemophilia. Int J Hematol 2021; 113:884-892. [PMID: 33677769 DOI: 10.1007/s12185-021-03104-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Abstract
Since the introduction of episodic and prophylactic treatments with safer factor concentrates, the life expectancy of people with haemophilia (PwH) has improved considerably. Ageing-related diseases such as cardiovascular disease (CVD) have also become more prevalent in PwH. This cross-sectional study aimed to evaluate CVD risk factors and estimate 10-year risk for CVD events among PwH. Male patients ≥ 30 years were interviewed and examined. Blood tests were performed at the local laboratory. Eighty-two patients were included, of whom 83% had haemophilia A and half had severe disease. Median age at study entry was 43.0 years (interquartile range [IQR], 36.0-51.3). Prevalence of obesity, systemic arterial hypertension (SAH) and diabetes mellitus were 16%, 60% and 16%, respectively. Hypertriglyceridaemia, hypercholesterolaemia and low HDL blood levels were present in 18%, 41% and 30% of patients, respectively. Metabolic syndrome was found in 37%. The Framingham Risk Score showed that 39% of PwH had a high risk of developing cardiovascular events in the following 10 years. We conclude that, in this cohort, PwH have a higher prevalence of SAH when compared with Brazilian men without haemophilia and about two-fifths have a high risk of developing a CVD event in the following 10 years.
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Affiliation(s)
- Ricardo Mesquita Camelo
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 2nd Floor, Room 255, Belo Horizonte, MG, 30130-100, Brazil. .,Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil. .,Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Camila Caram-Deelder
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.,Jon J Van Rood Centre for Clinical Transfusion Research, Sanquin/LUMC, Leiden, The Netherlands
| | - Bruna Pontes Duarte
- Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil
| | | | | | - Iris Maciel Costa
- Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil
| | | | - Ana Maria Vanderlei
- Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil
| | - Tania Maria Rocha Guimaraes
- Fundacao de Hematologia e Hemoterapia de Pernambuco (HEMOPE), Recife, Brazil.,Faculdade de Enfermagem Nossa Senhora das Gracas, Universidade de Pernambuco, Recife, Brazil
| | - Samantha Gouw
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.,Paediatric Haematology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Suely Meireles Rezende
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 2nd Floor, Room 255, Belo Horizonte, MG, 30130-100, Brazil
| | - Johanna van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.,Jon J Van Rood Centre for Clinical Transfusion Research, Sanquin/LUMC, Leiden, The Netherlands
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