# Factors Associated with Healthcare Utilization in Children with Sickle Cell Disease in Saudi Arabia

## TL;DR

This study examines how factors like complications and treatment choices affect healthcare use in Saudi children with sickle cell disease, revealing regional disparities and potential areas for improvement.

## Contribution

The study identifies specific clinical and regional factors influencing healthcare utilization in Saudi children with sickle cell disease within a high-resource system.

## Key findings

- Complication count and crisis episodes are key predictors of inpatient and emergency department visits.
- Regional disparities in healthcare use persist despite a publicly funded system.
- Hydroxyurea use and bone marrow transplants are associated with reduced emergency visits.

## Abstract

Public health relevance—How does this work relate to a public health issue?
This study addresses the substantial and costly burden that sickle cell disease (SCD) places on healthcare systems, a significant public health challenge in Saudi Arabia.It investigates patterns of healthcare resource consumption—inpatient, outpatient, and emergency care—highlighting system pressures from a major chronic pediatric condition.

This study addresses the substantial and costly burden that sickle cell disease (SCD) places on healthcare systems, a significant public health challenge in Saudi Arabia.

It investigates patterns of healthcare resource consumption—inpatient, outpatient, and emergency care—highlighting system pressures from a major chronic pediatric condition.

Public health significance—Why is this work of significance to public health?
It identifies modifiable clinical factors (e.g., complication count and crisis episodes) and treatment choices (e.g., hydroxyurea and transplant) that drive healthcare utilization, pointing to potential targets for intervention.It reveals significant regional disparities in service use within Saudi Arabia, underscoring inequities in healthcare access, delivery, or disease management that require public health attention.

It identifies modifiable clinical factors (e.g., complication count and crisis episodes) and treatment choices (e.g., hydroxyurea and transplant) that drive healthcare utilization, pointing to potential targets for intervention.

It reveals significant regional disparities in service use within Saudi Arabia, underscoring inequities in healthcare access, delivery, or disease management that require public health attention.

Public health implications—What are the key implications or messages for practitioners, policymakers, and/or researchers?
For policymakers and health system planners: Findings call for targeted resource allocation and strategies to mitigate regional disparities and support for preventive therapies (e.g., hydroxyurea) and curative options (e.g., transplant) that may reduce high-acuity visits over time.For clinicians and researchers: Results emphasize the importance of proactive complication management and systematic severity assessment (e.g., using comorbidity indices) in routine care to potentially prevent hospitalizations and optimize outpatient follow-up.

For policymakers and health system planners: Findings call for targeted resource allocation and strategies to mitigate regional disparities and support for preventive therapies (e.g., hydroxyurea) and curative options (e.g., transplant) that may reduce high-acuity visits over time.

For clinicians and researchers: Results emphasize the importance of proactive complication management and systematic severity assessment (e.g., using comorbidity indices) in routine care to potentially prevent hospitalizations and optimize outpatient follow-up.

(1) Background: In Saudi Arabia, a high-income country with a publicly funded healthcare system, sickle cell disease (SCD) remains a major pediatric health challenge. This study aimed to identify factors associated with healthcare utilization, specifically inpatient (IP), outpatient (OP), and emergency department (ED) visits, among children with SCD in Saudi Arabia. (2) Methods: A retrospective observational study was conducted using data from the KAIMRC registry (2015-2023), including 450 children under 12 years old diagnosed with SCD. Negative binomial regression models were employed to analyze the annual average visits, accounting for clinical, demographic, and regional healthcare resource variables. (3) Results: Key predictors of IP visits included complication count, crisis episodes, and region (eastern, western, and southern regions had higher utilization than central). ED visits were positively associated with complications, crisis episodes, and hydroxyurea use, but negatively associated with bone marrow transplant receipt. OP visits increased with higher Charlson Comorbidity Index scores, age, and bone marrow transplant, but were lower in the eastern region. (4) Conclusions: These findings highlight the influence of clinical and regional factors even within an equitable, high-resource healthcare system.