Geographic and Temporal Differences in Sickle Cell Disease Hospitalizations in New York State

Sickle cell disease (SCD) disproportionately affects racial and ethnic minority groups in the US and is associated with high levels of morbidity and health care utilization. However, population-level geographic differences and temporal variation in SCD hospitalization outcomes remain incompletely characterized.

To assess temporal and regional patterns of SCD hospitalizations in New York State from 2009 through 2022.

This retrospective cross-sectional study analyzed inpatient SCD hospitalizations recorded in the New York State Statewide Planning and Research Cooperative System deidentified database between January 1, 2009, and December 31, 2022. The analytic sample included 42 271 hospitalizations after exclusion of records with missing demographic, cost, or facility information. Data analysis was conducted from July 17, 2024, to February 14, 2025.

Hospitalization with SCD across 8 state-defined health service areas.

Outcomes included regional distribution of hospitalizations, mean length of stay, mean total charges, and trends in severity of illness and risk of mortality as defined by the All Patient Refined Diagnosis Related Groups classification system. Demographic and regional distributions were compared across years and regions.

Among 42 271 SCD hospitalizations (21 777 female [51.5%]), most occurred among individuals identified as Black (35 318 [83.6%) compared with White (750 [1.8%]), multiracial (242 [0.6%]), and other race or ethnicity 5956 (14.1%) and were aged 18 to 29 (16 794 [39.7%]) or 30 to 49 years (13 480 [31.8%]). New York City accounted for the largest proportion of hospitalizations statewide. There were significant differences in the length of stay and total charges across service areas; Central New York had the longest mean (SD) length of stay of 6.3 (7.3) days, followed by the Hudson Valley (6.2 [7.2]) days, while Long Island had the highest mean (SD) total charges at $59 476.3 ($63 823.5). The proportion of hospitalizations classified as major severity increased from 751 of 5897 (12.7%) in 2009 to 1011 of 3709 (27.3%) in 2022, and the proportion classified as major risk of mortality increased from 170 of 5897 (2.9%) to 469 of 3709 (12.6%) during the same period. Long Island had the highest proportion of hospitalizations with major risk of mortality (93 of 970 [9.6%]), whereas New York City exhibited one of the lower proportions of major risk of mortality (1531 of 27 923 [5.5%]) despite high hospitalization volume.

In this cross-sectional study, geographic and temporal differences in SCD hospitalization outcomes were observed across New York State during a 14-year period. These findings suggest the need for region-specific strategies to improve access to specialized care, reduce severe outcomes, and optimize health care resource use for individuals living with SCD.