Original article
Trends in Pediatric Sickle Cell Disease-Related Mortality in the United States, 1983-2002

https://doi.org/10.1016/j.jpeds.2008.09.052Get rights and content

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.

Section snippets

Methods

Information on the deaths of 0- to 14-year-old black children with SCD listed as a cause of death on the death certificate for 1983-2002 was extracted from the multiple-cause mortality files for the United States compiled by the Centers for Disease Control and Prevention's National Center for Health Statistics. The data set includes demographic information about deceased individuals, the underlying cause of death, and up to 20 disorders that are listed on death certificates. Causes of death

Results

The death certificate files compiled by the National Center for Health Statistics contained records of 276 158 deaths in black 0- to 14-year-olds during 1983-2002, of which 1 354 listed SCD as a diagnosis and met our inclusion and exclusion criteria. Of these, 230 did not list another cause of death other than sickle cell anemia (in 1983-1998) or SCD with or without crisis (in 1999-2002).

During the study period, SCD-related mortality rates in black children age 0 to 3 years declined by 68% (95%

Discussion

In contrast to a previous national study that reported comparable decreases in SCD-related mortality during 1968-1992 among black children of different age groups (1 to 4, 5 to 9, and 10 to 14 years),4 our analysis found a 68% reduction in SCD mortality in black children age 0 to 3 years during 1983-2002, a smaller but still significant decline (39%) in those age 4 to 9 years, and a statistically nonsignificant decline (24%) in those age 10 to 14 years. The decreased mortality in the latter age

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    • Cited by (0)

    The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors declare no potential conflicts of interest, real or perceived.

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