Clinical Complications, Mortality, and Healthcare Resource Utilization of Patients with Sickle Cell Disease with Recurrent Vaso-Occlusive Crises in Ontario, Canada: A Retrospective Cohort Study
Bibliographic record
Abstract
INTRODUCTION: Sickle cell disease (SCD) is characterized by vaso-occlusive crises (VOCs) that can lead to clinical complications, higher mortality, and healthcare resource use (HCRU). Lack of Canadian data poses challenges to health system planning, a gap this study intends to close. We analyzed clinical complications, mortality, and HCRU in patients with SCD with recurrent VOCs in Canada. METHODS: This retrospective cohort study identified patients with SCD with recurrent VOCs from the Institute for Clinical Evaluative Sciences (ICES) databases in Ontario, Canada from January 1, 2010, to December 31, 2021. VOCs were defined as SCD with crisis, priapism, or acute chest syndrome. Patients were matched (1:3) by age, sex, and geographic area with non-SCD individuals in the general population. Clinical complications, mortality, and HCRU were analyzed. RESULTS: Eight hundred fifty-nine patients with SCD with recurrent VOCs were identified and matched to 2577 controls. Mean (standard deviation [SD]) age was 22.1 (14.4) years; 50.9% were female. Mean (SD) rate of VOCs per person per year was 3.2 (4.4) in patients with recurrent VOCs. Acute and chronic complication rates were higher in patients than controls. Compared with controls, mortality was substantially higher for patients with recurrent VOCs. Mean (SD) age at death for patients with recurrent VOCs was 39.2 (17.2) years. There was significantly higher HCRU than matched controls (P < 0.0001). CONCLUSION: Patients with SCD with recurrent VOCs had substantially higher rates of complications, mortality, and HCRU than controls, further highlighting the need for novel therapies to reduce VOCs and the associated burden.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".