Attrition from Care and Clinical Outcomes in a Cohort of Sickle Cell Disease Patients in a Tribal Area of Western India
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Design and Setting
2.2. Study Population
2.3. Data Variables and Data Sources
2.4. Data Analysis
2.5. Ethical Approval
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Characteristics | Categories | n | (%) |
---|---|---|---|
Age in years | 0–13 | 105 | (26.0) |
14–29 | 246 | (60.9) | |
>30 | 53 | (13.1) | |
Gender | Male | 157 | (38.9) |
Female | 247 | (61.1) | |
Education * | No formal education | 45 | (11.1) |
Primary | 197 | (48.8) | |
Secondary and above | 162 | (40.1) | |
Occupation | Unemployed | 172 | (42.6) |
Employed | 75 | (18.6) | |
Student | 157 | (38.9) | |
Marital Status | Married | 168 | (41.6) |
Unmarried | 236 | (58.4) | |
Caste | Scheduled tribe | 401 | (99.3) |
Backward classes | 3 | (0.7) | |
Aerial distance of house address from SEWA Rural * in KM ** | <=20 | 164 | (40.6) |
20–50 | 201 | (49.8) | |
>=51 | 39 | (9.7) |
Characteristics | Categories | Children, N = 105 | Adults, N = 299 | Total | |||
---|---|---|---|---|---|---|---|
n | (%) | n | (%) | n | (%) | ||
Hospitalized at registration | Yes | 81 | (77.1) | 210 | (70.2) | 113 | (28.0) |
No | 24 | (22.9) | 89 | (28.8) | 291 | (72.0) | |
Number of pain crisis episodes in the last year | 0 | 23 | (21.9) | 25 | (8.4) | 48 | (11.9) |
1 | 21 | (20.0) | 42 | (14.0) | 63 | (15.6) | |
2 | 20 | (19.1) | 72 | (24.1) | 92 | (22.8) | |
>=3 | 41 | (39.0) | 160 | (53.5) | 201 | (49.8) | |
Number of hospitalizations in the last year | 0 | 76 | (72.4) | 197 | (65.9) | 273 | (67.6) |
1 | 18 | (17.1) | 66 | (22.1) | 84 | (20.8) | |
2 | 6 | (5.7) | 22 | (7.3) | 28 | (6.9) | |
>=3 | 5 | (4.8) | 14 | (4.7) | 19 | (4.7) | |
Number of blood transfusions in the last year | 0 | 89 | (84.7) | 243 | (81.3) | 332 | (82.2) |
1 | 9 | (8.6) | 30 | (10.0) | 39 | (9.7) | |
>=2 | 7 | (6.7) | 26 | (8.7) | 33 | (8.2) | |
Severe anemia | Yes | 24 | (22.9) | 37 | (12.4) | 61 | (15.1) |
No | 81 | (87.1) | 262 | (87.6) | 343 | (84.9) | |
Presence of sickle cell complications | Yes | 1 | (1.0) | 15 | (5.0) | 16 | (4.0) |
No | 104 | (99.0) | 284 | (95.0) | 388 | (96.0) | |
Genotype | HBS *- homozygous | 57 | (54.3) | 138 | (46.2) | 195 | (48.3) |
HBS *- B-thalassaemia | 2 | (1.9) | 4 | (1.34) | 6 | (1.5) | |
Not Available | 46 | (43.8) | 157 | (52.5) | 203 | (50.2) |
Characteristics | Categories | Person-years | LTFU | LTFU per 100 person-years | Unadjusted HR * (95% CI) | Adjusted HR * (95% CI) |
---|---|---|---|---|---|---|
Age in years | 0–13 | 147.0 | 21 | 14.3 | 1 | 1 |
14–29 | 313.2 | 73 | 23.3 | 1.6 (1.0–2.6) | 0.7 (0.3–1.3) | |
>30 | 73.2 | 18 | 24.6 | 1.8 (1.0–3.4) | 0.5 (0.2–1.2) | |
Gender | Male | 214.6 | 32 | 14.9 | 1 | |
Female | 318.8 | 80 | 25.1 | 1.7 (1.1–2.6) | 1.3 (0.8–2.1) | |
Education | NFE ** | 48.0 | 21 | 43.8 | 1.8 (1.1–3.0) | 1.4 (0.8–2.6) |
Primary | 282.1 | 43 | 15.2 | 0.7 (0.4–1.0) | 0.6 (0.4–0.9) | |
More than primary | 203.3 | 48 | 23.6 | 1 | 1 | |
Occupation | Unemployed | 211.7 | 55 | 26.0 | 1.8 (1.2–2.8) | 0.8 (0.4–1.6) |
Employed | 93.7 | 25 | 26.7 | 1.9 (1.1–3.1) | 0.9 (0.4–1.9) | |
Student | 228 | 32 | 14.0 | 1 | 1 | |
Marital Status | Married | 194.0 | 66 | 34.0 | 2.4 (1.7–3.5) | 3.2 (1.7–6.0) |
Unmarried | 339.4 | 46 | 13.6 | 1 | 1 | |
Caste | Scheduled tribe | 529.3 | 111 | 21.0 | 0.85 (0.1–6.5) | - |
Backward classes | 4.1 | 1 | 24.5 | 1 | ||
Distance | <=20 | 248.3 | 34 | 13.7 | 1 | 1 |
20–50 | 246.1 | 64 | 26.0 | 1.8 (1.2–2.7) | 1.5 (1.0–2.4) | |
>=51 | 39.0 | 14 | 35.9 | 2.2 (1.2–4.1) | 1.2 (0.6–2.4) |
Characteristics | Categories | Person-years | LTFU number | LTFU per 100 person-years | Unadjusted HR * (95% CI) | Adjusted HR * (95% CI) |
---|---|---|---|---|---|---|
Hospitalized at registration | Yes | 403.8 | 71 | 31.6 | 1.7 (1.1–2.5) | 1.7 (1.1–2.6) |
No | 129.6 | 41 | 17.6 | 1 | 1 | |
Number of pain crisis episodes in the last year | 0 | 75.9 | 6 | 7.9 | 1 | 1 |
1 | 86.9 | 23 | 26.5 | 3.1 (1.3–7.6) | 3.0 (1.2–7.5) | |
2 | 113.8 | 33 | 28.9 | 3.2 (1.4–7.7) | 3.6 (1.5–8.8) | |
>=3 | 256.7 | 50 | 19.5 | 2.1 (0.9–5.0) | 2.4 (1.0–5.7) | |
Number of hospitalizations in the last year | 0 | 349.5 | 72 | 20.6 | 1 | 1 |
1 | 115.3 | 24 | 20.8 | 1.1(0.7–1.7) | - | |
2 | 40.9 | 11 | 26.9 | 1.4 (0.8–2.7) | - | |
>=3 | 27.8 | 5 | 18.0 | 1.0 (0.4–2.4) | - | |
Number of blood transfusions in the last year | 0 | 423.9 | 91 | 21.4 | 1 | 1 |
1 | 54.2 | 16 | 29.5 | 1.48 (0.9–2.5) | 1.2 (0.7–2.1) | |
>=2 | 55.3 | 5 | 0.90 | 0.5 (0.2–1.2) | 0.3 (0.1–0.8) | |
Severe anemia | Yes | 70.4 | 98 | 19.9 | 0.9 (0.5–1.6) | - |
No | 463.0 | 14 | 21.2 | 1 | ||
Presence of sickle cell complications | Yes | 22.2 | 7 | 31.5 | 1.6 (0.8–3.5) | 1.1 (0.5–2.6) |
No | 511.2 | 105 | 20.5 | 1 | 1 |
Clinical Intervention * | Pre-registration, n | % | Post-registration, n | % |
---|---|---|---|---|
Received pneumococcal 23 vaccine | 46 | (11.4) | 332 | (82.2) |
Prescribed daily dose of folic acid during last visit | 358 | (88.6) | 380 | (94.1) |
Complete blood count done at least once in the last year | NA ** | NA ** | 321 | (79.5) |
Liver function tests done at least once in the last year | NA ** | NA ** | 245 | (60.6) |
Renal function tests done at least once in the last year | NA ** | NA ** | 247 | (61.1) |
Initiated hydroxyurea to eligible patients (N = 137) | 6 | (4.4) | 135 | (98.5) |
Prescribed hydroxyurea to eligible patients during last hospital visit (N = 137) | 6 | (4.4) | 82 | (59.9) |
Pain crisis rate (per 100 person-years) | 277 | - | 53.4 | - |
Hospitalizations rate (per 100 person-years) | 49.8 | - | 42.2 | - |
Blood transfusion rate (per 100 person-years) | 27.4 | - | 17.8 | - |
Hemoglobin level (g/dL) during last visit (mean (SD)) | 8.66 | - | 9.4 | - |
Diagnosed at least once with severe anemia *** the in last year, n (%) | 61 | (15.1) | 16 | (4.0) |
Diagnosed with at least one sickle cell complication in the last year | 16 | (4.0) | 31 | (7.7) |
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Dave, K.; Chinnakali, P.; Thekkur, P.; Desai, S.; Vora, C.; Desai, G. Attrition from Care and Clinical Outcomes in a Cohort of Sickle Cell Disease Patients in a Tribal Area of Western India. Trop. Med. Infect. Dis. 2019, 4, 125. https://doi.org/10.3390/tropicalmed4040125
Dave K, Chinnakali P, Thekkur P, Desai S, Vora C, Desai G. Attrition from Care and Clinical Outcomes in a Cohort of Sickle Cell Disease Patients in a Tribal Area of Western India. Tropical Medicine and Infectious Disease. 2019; 4(4):125. https://doi.org/10.3390/tropicalmed4040125
Chicago/Turabian StyleDave, Kapilkumar, Palanivel Chinnakali, Pruthu Thekkur, Shrey Desai, Chandrakant Vora, and Gayatri Desai. 2019. "Attrition from Care and Clinical Outcomes in a Cohort of Sickle Cell Disease Patients in a Tribal Area of Western India" Tropical Medicine and Infectious Disease 4, no. 4: 125. https://doi.org/10.3390/tropicalmed4040125