Death in Patients Hospitalized for Sickle Cell Not Linked with Opioid Use

Despite an increase in hospitalization rates among most age groups of adults with sickle cell disease, there has been no associated increase in in-hospital sickle cell disease mortality, according to a study presented at the 60th ASH Annual Meeting and Exposition. These data suggest that the rate of opioid-related deaths in sickle cell disease is low and that the use of opioids for pain control among these patients may be considered relatively safe.

“We do not see a relationship between opioid use and death in patients who are hospitalized for sickle cell disease,” Oladimeji Akinola Akinboro, MBBS, of Boston University School of Medicine and Boston Medical Center, said in a prepared statement.

“We expected that if opioid-related mortality had increased in this population, the increase would be apparent in hospital inpatient mortality data,” Akinola said. “It is reassuring to find that opioid use during acute pain crisis does not seem to have led to higher mortality in this population.”

Opioids are a mainstay of treatment among patients with sickle cell disease experiencing vaso-occlusive pain crises. With the documented increase in opioid-related deaths in the United States, this study was designed to examine if there have been more hospitalizations of patients with sickle cell since the onset of this epidemic and if in-hospital mortality rates for these patients with those of the general population.

To do that, Akinboro and colleagues use data from the National Inpatient Sample from 1998 through 2013. They identified more than 1.7 million hospitalizations for sickle cell disease and examined in-hospital mortality rates for all patients and by age groups.

Although data indicated an initial decline in hospitalization rates for patients with sickle cell disease from 1998 to 2002, among adults aged 18 to 44, there was a significant 3.8% annual increase in hospitalization from 43 per 100,000 person in 2002 to 71 per 100,000 persons in 2013. Additionally, patients aged 65 or older had a 6.5% annual increase in hospitalization rates from, 2.7 per 100,000 persons in 1998 to 5.4 per 100,000 persons in 2013.

No increase in in-hospital sickle cell disease mortality was seen during the study period. In contrast, there was a 350% increase in non-sickle cell opioid prescription-related death rates in the United states from 1999 to 2013.

According to Akinboro, further researcher is needed to clarify the reasons why hospitalization rates climbed in these two age groups, but he suspects one reason may be lack of coordination of medical care for adults with sickle cell disease. Another possible explanation is that people with sickle cell disease are now living longer than they did in the past and are developing other health problems as they age.

Akinboro OA, et al. Opioid use if not associated with in-hospital mortality among patients with sickle cell disease in the United States: Findings from the National Inpatient Sample. Presented at 60th Annual ASH Meeting and Exposition; December 1-4, 2018; San Diego. Abstract #315.