Hospitalization and Mortality due to COVID-19 among People born 1987-2019 with Sickle Cell Disease or Sickle Cell Trait in Michigan

Abstract

Background
Sickle cell disease (SCD) is a rare, genetic hemoglobinopathy considered to be a risk factor for severe COVID-19 outcomes. Some evidence suggests that individuals with sickle cell trait (trait), the carrier state of SCD, may also be at risk for severe COVID-19 outcomes. To date, there have been no studies that assess COVID-19 outcomes in those living with SCD and trait at the population level.
Objective
Assess COVID-19 related hospitalization and mortality among those living with SCD or trait using population-based cohorts in the state of Michigan.

Methods
We linked all COVID-19 infections in the Michigan Disease Surveillance System from March 2020-November 2021 to births in newborn screening records (NBS) from 1987-2019 in the state of Michigan. Individuals that did not link, had an unknown NBS hemoglobin result, or had an abnormal, non-sickle cell hemoglobinopathy were excluded from analysis. Race, sex, and age were obtained from NBS; COVID-19 hospitalization and mortality were obtained from the Michigan Disease Surveillance System. We used logistic regression models with generalized estimating equations (GEE) to assess the relationship between hemoglobin status (normal hemoglobin, SCD, trait), COVID-19 hospitalization, and COVID-19 mortality. GEE was used to account for individuals with multiple infections. We limited models to those identified as Black race due to missing race data concerns across all hemoglobin groups. Models were adjusted for sex and age.

Results
We linked 329,552 infections among individuals ages 0 to 33 from the COVID-19 registry to NBS records (98.7% normal hemoglobin, 0.1% SCD, 1.2% trait). Of those that linked, 14.0% (n=45,630) were identified as Black race. For those identified as Black race, the adjusted odds of hospitalization for SCD was 15.4 (95% CI: 10.4, 22.9) times greater than the normal hemoglobin group. The adjusted odds of death due to COVID-19 in those with SCD was 15.9 (95% CI: 4.8, 52.5) times greater than the normal hemoglobin group. We did not find a significant difference in odds of hospitalization or death between the trait and normal hemoglobin groups.
Conclusion
Individuals with SCD are at a higher risk of severe COVID-19 outcomes compared to individuals with normal hemoglobin; however, trait does not appear to be a significant risk factor. These results demonstrate that vaccinations and access to early COVID-19 treatments are important to promote among populations living with SCD.

Categories: Conference Abstracts/Posters