Socio-economic deprivation and risk of emergency readmission and inpatient mortality in people with sickle cell disease in England: observational study

J Public Health (Oxf). 2013 Dec;35(4):510-7. doi: 10.1093/pubmed/fdt100. Epub 2013 Oct 29.


Background: Sickle cell disease (SCD) is a cause of frequent emergency readmissions. We examined trends in SCD emergency readmissions and inpatient mortality in England in relation to socio-economic status.

Methods: Data from Hospital Episode Statistics were extracted for all SCD patients admitted in 2005/06. The financial year 2005/06 was taken as the index year for analysis. We calculated readmission rates and inpatient mortality for patients admitted with a primary or secondary diagnosis of sickle cell anaemia with crisis and without crisis in the index year during the subsequent 5 years (2006/07-2010/11). Charlson Score was used to measure comorbidity. Using Cox proportional hazards models, we also examined the relationship between patient characteristics and both emergency readmissions and inpatient mortality.

Results: In 2005/06, there were 7679 SCD index admissions. Over the subsequent 5-year period, patients living in the most socio-economically deprived areas were at highest risk of readmission (54.2% readmitted over the study period compared with 28% of the least deprived group). Inpatient mortality amongst readmissions was highest in patients living in the most deprived areas [hazard ratio (HR) 2.34, 95% CI 1.41-3.90].

Conclusion: SCD patients from the most socio-economically deprived areas and with comorbidities are at highest risk of both SCD readmissions and in-hospital mortality, suggesting that there are inequalities in healthcare access and health outcomes amongst people with SCD.

Keywords: chronic disease; management and policy; socioeconomics factors.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anemia, Sickle Cell / mortality*
  • Child
  • Child, Preschool
  • Emergency Service, Hospital / statistics & numerical data*
  • England / epidemiology
  • Female
  • Healthcare Disparities / statistics & numerical data
  • Hospital Mortality*
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Patient Readmission / statistics & numerical data*
  • Poverty / statistics & numerical data*
  • Risk Factors
  • Socioeconomic Factors
  • Young Adult