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Updated: Jun 22, 2025
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Shift in emergency department utilization by frequent attendees with sickle cell disease during the COVID-19
J S Rech1,2,3,4, A Cohen5, P Bartolucci6,7
1Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Réseau Sentinelles, Paris, France.
Insights
COVID-19 lockdowns reduced emergency department (ED) visits for sickle cell disease (SCD) patients. While most returned to baseline, frequent ED users showed a lasting decrease in visits, suggesting potential changes in healthcare access or management.
Area of Science:
- Hematology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic and associated lockdowns may have altered healthcare utilization patterns for individuals with sickle cell disease (SCD).
- Understanding these changes is crucial for managing SCD patient care and optimizing emergency department (ED) resource allocation.
Purpose of the Study:
- To assess the impact of the COVID-19 pandemic and lockdowns on ED visit rates among adult patients with SCD.
- To specifically investigate the effect on 'high users' of ED services.
Main Methods:
- A self-controlled case series design was employed to analyze ED visit data from 1530 adult SCD patients across five French centers.
- Data spanned from January 1, 2015, to December 31, 2021, comparing pre-pandemic periods with lockdown phases.
Main Results:
- A significant reduction in ED visits was observed during and immediately following COVID-19 lockdowns (IRRs 0.59-0.66), with effects diminishing over time.
- While most patients' ED utilization returned to baseline by April 2021, a sustained decrease was noted among high users (≥10 visits in 2019).
- High users, representing 4% of patients, accounted for 33.7% of total ED visits, significantly influencing the observed reductions.
Conclusions:
- COVID-19 lockdowns were associated with a temporary decrease in ED visits for SCD patients.
- The persistent reduction in ED utilization among high users warrants further investigation to understand underlying factors and inform future healthcare strategies for this vulnerable population.
Abstract:
While the coronavirus disease-2019 (COVID-19) might have increased acute episodes in people living with sickle cell disease (SCD), it may also have changed their reliance on emergency department (ED) services. We assessed the impact of the COVID-19 pandemic and lockdowns on ED visits in adult SCD people followed in five French reference centres, with a special focus on 'high users' (≥10 visits in 2019). We analysed the rate of ED visits from 1 January 2015 to 31 December 2021, using a self-controlled case series. Among 1530 people (17 829 ED visits), we observed a significant reduction in ED visits during and after lockdowns, but the effect vanished over time. Compared to pre-pandemic, incidence rate ratios for ED visits were 0.59 [95% CI 0.52-0.67] for the first lockdown, 0.66 [95% CI 0.58-0.75] for the second and 0.85 [95% CI 0.73-0.99] for the third. High users (4% of people but 33.7% of visits) mainly drove the reductions after the first lockdown. COVID-19 lockdowns were associated with reduced ED visits. While most people returned to their baseline utilization by April 2021, high users had a lasting decrease in ED visits. Understanding the factors driving the drop in ED utilization among high users might inform clinical practice and health policy.
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