County Adults age 21 or older Children and young adults Total
Los Angeles 1213 480 1693
San Bernardino 255 162 417
Sacramento 230 113 343
Alameda 239 92 331
Riverside 203 97 300
San Diego 180 65 245
Contra Costa 168 68 236
San Joaquin 97 39 136
Solano 91 43 134
San Francisco 86 26 112
Fresno 63 47 110
Orange 73 31 104
Kern 62 35 97
Santa Clara 57 16 73

Since 2010, 12% of newborns with SCD are Hispanic ethnicity.

The 1,500 Hispanic infants who did test positive for trait made up 37% of the 4,000 babies identified with sickle cell trait in 2010. Fewer than 1% of the ~250,000 Hispanic newborns tested that year were found to carry sickle cell trait, however. These data are provided by the state’s Newborn Screening Program and the Centers for Disease Control and Prevention.

SCDC data shows that 8% are Hispanic ethnicity, with proportions higher in younger age groups and lower in older age groups.

We looked at CA SCDC data for 2016 from the six counties with the largest SCD population. Billed charges are typically considerably higher than what is reimbursed to the hospital and providers, so we included a rough estimate of likely reimbursement from insurers. The charges are only for the inpatient stays. We do not have information on ED (if not admitted) charges.

County Age Admissions Billed Charges
Est. Reimbursement
Emergency Dept. Visits
(discharged to home)
Los Angeles < 21 years 364 $36 $9 514
21 and over 1,881 $117 $29 3,850
San Bernardino < 21 years 157 $10 $3 256
21 and over 484 $28 $7 711
Sacramento < 21 years 69 $5 $1.3 117
21 and over 311 $21 $5 519
Alameda < 21 years 122 $7 $2 174
21 and over 373 $29 $7 724
Riverside < 21 years 83 $4 $1 85
21 and over 313 $16 $4 466
San Diego < 21 years 80 $2 $0.5 51
21 and over 317 $15 $4 682

2005 data on number of patients, hospitalizations, and emergency department (ED) visits for SCD in California (CA) are available online. Data for 2010-2016 will be available shortly.

Between 75 and 100 newborns are diagnosed with sickle cell disease at birth. About 3,500 newborns carry sickle cell trait. About 10% of births with sickle cell disease are Hispanic non Black, while nearly 40% of sickle cell trait identified newborns are Hispanic non Black. The rest are nearly all Black non Hispanic newborns, with a small number of White, Native American or Asian babies.

Children living with this disease in California usually have access to excellent care. A team of a pediatric hematologist and other specialists can work together with the child’s pediatrician to provide quality health care for both sickle cell related issues and the care for health problems and preventative care that all children need. A list of pediatric care centers is here.

While excellent care is available for adults living with sickle cell disease in the state, it can be hard to access due to insurance issues, hours of availability, and distance/transportation. The American Society of Hematology has a list of providers who see patients with SCD, and those transitioning from pediatric to adult care should work with their pediatric hematology team to assure a connection is made with an adult provider.

This disease is severe and can mean a high number of hospital inpatient stays. Additionally, pain crises bring patients to the emergency room when severe. That means the statewide cost for sickle cell is very high.

Billed charges for sickle cell inpatient stays in 2014 not including HMO systems totaled over $400 million, and about half of those charges were covered by Medi-Cal/Medicaid alone. The remainder were dual eligible (Medicaid/Medicare), private payer, some other government program, or self pay.

Estimates combining state emergency room treat and release visit data and federal ‘typical charge’ data tell us that there were 10,790 visits to the emergency room for sickle cell related causes in California in 2014 that did not result in admission, totaling $338 million in charges.

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    Data Sources

    California Rare Disease Surveillance Program

    Sickle Cell Data Collection Project

    The SCDC collects and analyzes data on the health and health care of Californians living with SCD.

    The data will help improve the health, outcomes and quality of life of these Californians by informing decisions about how best to meet their needs. The project is run by the California Rare Disease Surveillance Program, a part of the California Environmental Health Tracking Program and the Public Health Institute.

    Project Overview

    A longitudinal data collection system collects consistent information about the health and heath care of a specific group of people (population) over long periods of time in order to study trends. This project will meet the following objectives:

    1. Help understand how many people are living with SCD in California and their health status;
    2. Provide information needed to establish cost-effective practices that help improve and potentially extend the lives of people with SCD;
    3. Determine how well current systems of care are meeting the needs of people with SCD and inform the development of new models of care that may better meet those needs; and
    4. Provide accurate, up-to-date information and guidance for clinical care providers, patients, families, advocates, policy makers and government agencies.

    This project is the first step in building a sustainable data collection system that could include information on everyone diagnosed with SCD in the United States, not just those who are seen in comprehensive care centers.

    All of the data will be de-identified that is, the data system will not contain names, social security numbers, dates of birth, or other types of information that could be used to identify individual patients. Data are collected from already existing sources such as newborn screening diagnoses, insurance claims data, and state hospitalization data.

    Project Materials

    APHA 2017 Maternal Mortality (pdf)

    ASH 2017 County Surveillance (pdf)

    ASH 2017 SCD Mortality in CA (pdf)

    ASH 2016 Episodic ED Utilization (pdf)

    ASH 2016 Pregnancy Outcomes (pdf)

    SCDAA 2016 Public Health Agenda (pdf)

    Longitudinal Data Collection for Sickle Cell Disease in California Dec. 2015 Report (pdf) 

    Previous Projects and Materials

    Before the Sickle Cell Data Collection program in California, two earlier projects showed the need for data collection on sickle cell disease.

    California was one of seven states to participate in a cooperative agreement with the Centers for Disease Control (CDC) and the National Heart, Lung and Blood Institute (part of the National Institutes of Health) in the Registry and Surveillance System for Hemoglobinopathies (RuSH, 2010-2012).

    RuSH led to a follow up CDC-funded validation project in California and Georgia called the Public Health, Research, Epidemiology and Surveillance in Hemoglobinopathies (PHRESH, 2012-2014).

    PHRESH educational materials include the following:

    California Sickle Cell Disease Fact Sheet  General public version (pdf)

    California Sickle Cell Disease Fact Sheet  Provider version (pdf)

    Sickle Cell Disease Public Service Announcement (pdf)

    For more on CDC sickle cell data collection activities

    Centers for Disease Control (CDC)

    Sickle Cell Data Collection

    Useful in Describing Patterns of Emergency Department Visits by Californians with Sickle Cell Disease (SCD)

    Medical care for children and adults living with sickle cell disease (SCD) is often provided in the emergency department (ED) within hospitals or clinics when problems cannot be successfully treated at home or during a doctor’s office visit. How frequently a patient uses the ED may also be related to healthcare system factors, such as lack of access to health care, few or no SCD healthcare experts located nearby, or inadequate or no insurance coverage to pay for medical services. Previous research suggests that between one-half and two-thirds of SCD patients’ ED visits end in a discharge from the ED, called a treat-and-release visit. The remainder result in admission to a hospital or other treatment facility.

    About This Study

    The purpose of this study was to use data from the Sickle Cell Data Collection (SCDC) program to

    1. Describe patterns of use of the ED for treat-and-release visits by California’s SCD population; and
    2. Compare and contrast these new findings with results of previous studies.

    ED and hospital discharge data from 2005-2014 were studied to determine the patterns of ED treat-and-release for people with SCD in California.

    Key findings from this report are highlighted below and we invite you to read the scientific summary of the article.

    Main Findings
    • Among 4,636 patients with SCD in California, almost 9 in 10 had one or more treat-and-release ED visits during the 10 year study period (2005-2014).
    • The average number of visits each year to the ED for the participants in the study was 2.1 visits.
    • In a single year,
      • About 5 in 10 patients with SCD had no treat-and-release ED visits (No ED use),
      • About 3 in 10 patients had between 1 and 3 visits (Low ED use),
      • About 1 in 10 patients had between 4 and 10 visits (Medium ED use), and
      • About 1 in 30 patients had 11 or more visits (High ED use).
    • Younger adults and older adults had a greater number of ED visits than pediatric patients (patients who were children).

    Researchers can study these ED visits to better understand the changes in health care and health policy that might lead to the improvement and extension of life for people with SCD.