The Role of Associated Treatment Factors and Mental Health on Transition From Pediatric to Adult Care for Adolescent/Young Adults With Sickle Cell Disease.

BACKGROUND

Adolescents and young adults (AYA) living with sickle cell disease (SCD) transitioning to adult hematology care are at risk of dropping out of care and relying on emergency departments (ED) for acute crisis management. This can result in decreased continuity of care, an increase in serious health complications, and a greater mortality risk. This study aimed to investigate how transitioning to adult care is associated with SCD treatment outcomes, and test whether this association is moderated by comorbid mental health concerns (i.e., symptoms of anxiety and depression).

PROCEDURE: We tested differences by age group (16-20, 21-25, 26-33 years) in the number of opioid prescriptions, hydroxyurea prescriptions, and ED visits using unadjusted comparisons and multivariable regression models, hypothesizing increased acute care use and decreased preventive treatment among the older age groups due to the complications associated with transitioning to adult care. We also tested whether there was an exacerbating effect of depression and anxiety symptoms on transition by assessing interaction terms between age group and symptoms in regression models.

RESULTS

After adjusting for sociodemographic and mental health symptoms, the 26-33-year-old group had a significantly higher number of opioid prescriptions, and the 21-25 and 26-33 year groups had fewer hydroxyurea prescriptions and a greater number of ED visits than their 16-20-year-old counterparts. The higher number of opioid prescriptions among the older age group was even more pronounced among those with moderate to severe anxiety symptoms.

CONCLUSIONS

Transitioning from pediatric to adult hematology poses a significant risk for AYA with SCD, especially for those with anxiety symptoms.