Cohort Tracking of Sickle Cell Trait-Positive Births Identified by Newborn Screening, California, 1991-2013: Public Health Surveillance for Sickle Cell Trait.

OBJECTIVES

Sickle cell trait (SCT) is the carrier status for sickle cell disease, and people with SCT have both hemoglobin A (HbA) and sickling hemoglobin (HbS). SCT is generally regarded as a benign condition, but clinical complications can be substantial. No registry or surveillance system exists to track health outcomes for people with SCT; this study aimed to identify methodology for surveillance.

METHODS

This longitudinal analysis included all live births with SCT identified by the California Department of Public Health Newborn Screening (NBS) Program from 1991 through 2013 and 3 matched controls per newborn, linked to death data in California for 1991-2013.

RESULTS

There were 94 240 live births with SCT and 282 720 matched healthy controls; 693 (0.74%) deaths occurred in the SCT group, and 1910 (0.68%) deaths occurred among the matched controls. Those with SCT had an increased mortality hazard ratio (MHR) compared with matched controls (11% higher; P = .02). When stratified, the MHR was higher among those aged 1 to 4 years (44% higher; P < .001) and 5 to 14 years (48% higher; P = .005) than among the matched controls. Examination of causes of death showed only a slightly higher-than-expected risk of death due to respiratory causes among people with SCT.

CONCLUSIONS

These findings highlight the need for population-level research, including investigation into causes of death, to inform clinical management and counseling for SCT. Other states may replicate this methodology with population-based data sources. Further surveillance of the health of those with SCT is needed.