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COVID-19 in individuals with sickle cell disease/trait compared with other Black individuals

Ashima Singh¹, Amanda M Brandow^1,2, Julie A Panepinto^1,2

¹Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI; and.

|April 1, 2021

Insights

Black individuals with Sickle Cell Disease (SCD) faced higher risks of COVID-19 hospitalization, pneumonia, and pain. Sickle Cell Trait (SCT) did not significantly alter COVID-19 outcomes compared to Black individuals without SCD or SCT.

Area of Science:

Hematology
Infectious Diseases
Public Health

Background:

COVID-19 disproportionately impacts Black populations in the U.S.
Sickle Cell Disease (SCD) and Sickle Cell Trait (SCT) are prevalent genetic conditions among Black individuals.
The comparative risk of severe COVID-19 outcomes for individuals with SCD/SCT versus those without is not well-established.

Purpose of the Study:

To compare COVID-19 outcomes, including disease manifestations, hospitalization rates, and mortality, between Black patients with SCD/SCT and Black patients without SCD/SCT.
To investigate potential differential risks associated with COVID-19 infection in individuals with SCD and SCT.

Main Methods:

Utilized electronic health record data from a multisite research network.
Identified Black patients diagnosed with COVID-19 between January 20, 2020, and September 20, 2020.
Employed 1:1 propensity score matching based on age, sex, and comorbidities to compare outcomes between groups.

Main Results:

Patients with COVID-19 and SCD showed significantly higher risks of hospitalization (RR, 2.0), pneumonia (RR, 2.4), and pain (RR, 3.4) compared to Black individuals without SCD/SCT.
No significant differences in case fatality rates were observed between patients with SCD and Black individuals without SCD/SCT.
Individuals with SCT did not exhibit significant differences in COVID-19 outcomes compared to Black individuals without SCD/SCT in matched cohorts.

Conclusions:

COVID-19 patients with Sickle Cell Disease face elevated risks for severe illness manifestations, including hospitalization and pneumonia.
Sickle Cell Trait does not appear to confer a significantly different risk for adverse COVID-19 outcomes.
Further research is needed to understand the specific mechanisms driving increased COVID-19 severity in SCD patients.

Read full analysis

Abstract:

In the United States, COVID-19 has disproportionately affected Black persons. Sickle cell disease (SCD) and sickle cell trait (SCT) are genetic conditions that occur predominantly among Black individuals. It is unknown if individuals with SCD/SCT are at higher risk of severe COVID-19 illness compared with Black individuals who do not have SCD/SCT. The objective of our study was to compare COVID-19 outcomes, including the disease manifestations, hospitalization, and death, among individuals with SCD/SCT vs Black individuals who do not have SCD/SCT. We leveraged electronic health record data from a multisite research network to identify Black patients with COVID-19 who have SCD/SCT and those who do not have SCD/SCT. During the study period of 20 January 2020 to 20 September 2020, there were 312 patients with COVID-19 and SCD and 449 patients with COVID-19 and SCT. There were 45 517 Black persons who were diagnosed with COVID-19 but who did not have SCD/SCT. After 1:1 propensity score matching (based on age, sex, and other preexisting comorbidities), patients with COVID-19 and SCD remained at a higher risk of hospitalization (relative risk [RR], 2.0; 95% CI, 1.5-2.7) and development of pneumonia (RR, 2.4; 95% CI, 1.6-3.4) and pain (RR, 3.4; 95% CI, 2.5-4.8) compared with Black persons without SCD/SCT. The case fatality rates for those with SCD compared with Black persons without SCD/SCT were not significantly different. There also were no significant differences in COVID-19 outcomes between individuals with SCT and Black persons without SCD/SCT within the matched cohorts.

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