Age‐ and sex‐specific rates of gall bladder disease in children with sickle cell disease

Abstract

Background Children with sickle cell disease (SCD) have an increased risk for gallstones due to chronic hyperbilirubinemia from hemolysis. Although gallstones are a known complication, there is variability in estimates of disease burden and uncertainty in the association between sex and gall bladder disease (GBD). Methods This was a retrospective cohort study of children with SCD using administrative claims data (January 1, 2014–December 31, 2018). Population‐averaged multivariable panel‐data logistic regression models were used to evaluate the association between GBD clinical encounters (outcome) and two exposures (age and sex). Annual GBD risk was calculated using predictive margins, adjusting for disease severity, transfusion frequency, and hydroxyurea exposure. Results A total of 13,745 individuals (of 21,487 possible) met inclusion criteria. The population was evenly split across sex (49.5% female) with predominantly Medicaid insurance (69%). A total of 946 individuals (6.9%) had GBD, 432 (3.1%) had a gallstone complication, and 487 (3.5%) underwent cholecystectomy. The annual risk of GBD rose nonlinearly from 1 to 5% between ages 1 and 19 years with no difference between males and females. Cholecystectomy occurred primarily in individuals with GBD (87%), and neither age nor sex was associated with cholecystectomy in this population. High disease severity (compared with low) more than doubled the annual risk of GBD at all ages. Conclusions GBD is associated with age but not sex in children with SCD. Neither age nor sex is associated with risk of cholecystectomy. High disease severity increases the rate of GBD at all ages.

Comment on: Evaluating age and sex‐specific rates of gall bladder disease in children with sickle cell disease

“…To the Editor, The article by Agawu et al "Evaluating age and sex-specific rates of gall bladder disease (GBD) in children with sickle cell disease (SCD)" piqued our interest. 1 This study confirms that age, but not gender, is significantly associated with the incidence of gall bladder disease in paediatric patients with sickle cell disease. The large sample size of 13,745 individuals drawn from diverse geographic regions across the United States enhances the generalizability of the findings.…”