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Trends in pediatric sickle cell disease-related mortality in the United States, 1983-2002
Emad Yanni1, Scott D Grosse, QuanHe Yang
1National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. eyanni@cdc.gov
Insights
Sickle cell disease (SCD) mortality in Black children under 4 has significantly decreased, possibly linked to the pneumococcal vaccine. Older children with SCD show no similar recent mortality reduction, highlighting a need for new treatments.
Area of Science:
- Pediatric Health
- Hematology
- Public Health Surveillance
Background:
- Sickle Cell Disease (SCD) is a serious inherited blood disorder disproportionately affecting Black children.
- Understanding mortality trends in pediatric SCD is crucial for assessing healthcare interventions and outcomes.
Purpose of the Study:
- To analyze temporal trends in sickle cell disease-related mortality among Black children in the United States from 1983 to 2002.
- To identify age-specific changes in SCD mortality rates over a 20-year period.
Main Methods:
- Utilized multiple-cause mortality data from the National Center for Health Statistics (NCHS) for deaths among children aged 0-14 years.
- Focused analysis on deaths where sickle cell disease was listed as a cause for children identified as Black.
Main Results:
- SCD mortality rates decreased significantly from 1983-1986 to 1999-2002: 68% for ages 0-3, 39% for ages 4-9, and 24% for ages 10-14.
- A notable 42% reduction in mortality for ages 0-3 was observed between 1995-1998 and 1999-2002.
- No significant recent reduction in SCD mortality was found for children aged 4-14.
Conclusions:
- The decline in SCD mortality among young Black children (<4 years) coincides temporally with the 2000 introduction of the 7-valent pneumococcal conjugate vaccine.
- The lack of recent mortality improvements in older children (4-14 years) underscores the urgent need for novel therapeutic strategies and interventions for sickle cell disease.
Objective:
To analyze trends in sickle cell disease (SCD)-related mortality among black children during 1983-2002.
Study Design:
Using the multiple-cause mortality files compiled by the Centers for Disease Control and Prevention's National Center for Health Statistics, we analyzed deaths among children classified as black who were age 14 years and younger and had SCD identified on their death certificates.
Results:
Relative to the rate for 1983-1986, the SCD mortality rate for 1999-2002 decreased by 68% (95% confidence interval [CI]=58% to 75%) at age 0 to 3 years, by 39% (95% CI=16% to 56%) at age 4 to 9 years, and by 24% (95% CI= -9% to 47%) at age 10 to 14 years. For the most recent period studied, a significant (42%) reduction in mortality at age 0 to 3 years was seen between 1995-1998 and 1999-2002, with essentially no reduction in SCD mortality at older ages.
Conclusions:
Recent decreases in SCD mortality in black children under age 4 years coincided with the introduction of the 7-valent pneumococcal conjugate vaccine in 2000, although temporal association is not evidence of causation. The lack of significant recent reduction in SCD mortality in older children indicates the need for new treatment approaches.
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