03/07/2026
As they shift from pediatric to adult care, young adults with sickle cell disease (SCD) appear to visit the emergency room more often and be prescribed less hydroxyurea, a preventive treatment approved to reduce the frequency of painful crises.
Data shows that patients ages 24 to 33 years were prescribed a significantly higher number of opioids — strong analgesics used during painful crises — than those ages 16 to 20 years. This trend was particularly pronounced among young adults with moderate to severe symptoms of anxiety.
As with any disease, this transition can be challenging. When adolescents change doctors as they move to adult care, many stop regular visits and rely on emergency services instead. This can break the continuity of their treatment and increase the risk of serious complications and even death.
To investigate whether transitioning to adult care influences SCD treatment outcomes, data was obtained from 1,581 adolescents and young adults with SCD living in the U.S. Most were female (68%) and Black or African American (59.5%).
Participants were divided into three age groups: before the transition (16-20), during the transition (21-25), and after the transition (26-33). The team also examined whether mental health — specifically anxiety and depression — had any impact on this transition.
The two older groups, representing patients during and after the care transition, were less frequently prescribed hydroxyurea, a therapy used to lower the frequency of SCD complications. Consistent with this finding, these two groups had significantly more emergency room visits, suggesting greater reliance on emergency services.
SCD aged 21-33 demonstrated utilizing emergency at higher rates, which can compromise the continuity of care when they are not connected and engaged with an [appropriate healthcare] provider,” the researchers wrote.
The two older groups were also more likely to experience moderate to severe symptoms of anxiety than the group of patients not yet transitioning to adult care.
[These findings suggest] a pattern of increased acute care use and decreased preventive treatment as patients with SCD transition to adult care. These higher rates can also be associated with increased disease burden, as people with SCD age, which requires greater intervention.
Further prescriptions and a less pronounced reduction in hydroxyurea prescriptions in patients ages 21-25. In contrast, more anxiety in those aged 26-33 was associated with an even lower number of hydroxyurea prescriptions.
Depression, but not anxiety, was linked to increased emergency use. Patients with more severe symptoms of depression were more likely than those with milder symptoms to visit the emergency room within 30 days (10% vs. 3%) and three months.
The research will continue with more outcomes to be obtained so we can learn more about the transition from pediatric to adult care.
