{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:27:52Z","timestamp":1783445272604,"version":"3.54.6"},"reference-count":53,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Youths with sickle cell anemia (SCA) are at risk of pain crises, stroke, and early death. Complications can be reduced by the oral disease-modifying medication hydroxyurea, and in 2014, the National Heart, Lung, and Blood Institute published revised guidelines that hydroxyurea should be offered to youths aged 9 months and older with SCA regardless of disease severity.<\/jats:p><\/jats:sec>Objective<\/jats:title>To describe changes in hydroxyurea use among youths with SCA before and after release of the National Heart, Lung, and Blood Institute guidelines.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cross-sectional study was conducted using administrative data from 2010 to 2018 from Michigan and New York State (NYS) Medicaid programs. The study population included youths aged 1 to 17 years with SCA enrolled in the Michigan or NYS Medicaid programs for at least 1 year (Michigan: 2010-2018; NYS: 2012-2018). Youths with SCA were identified using validated claims\u2013based definitions. Data were analyzed from June to October 2020.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The main outcome was hydroxyurea use characterized as mean annual counts of days\u2019 supply of filled hydroxyurea prescriptions. Rates of hydroxyurea use over time were assessed using regression models (Michigan: zero-inflated negative binomial; NYS: negative binomial). Models included indicators for periods before and after guideline release.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 4302 youths with SCA (2236 males [52.0%]; 2676 born 2005-2017 [62.2%]; 150 Hispanic [3.5%], 2929 non-Hispanic Black [68.0%], and 389 non-Hispanic White [9.0%]) contributed 12\u202f565 person-years. The mean (SD) annual days\u2019 supply of hydroxyurea was 47.2 (93.6) days per youth in Michigan and 97.4 (137.0) days per youth in NYS. In Michigan, there was an increase in the odds of having nonzero days\u2019 supply after the guidelines were released (odds ratio, 1.52; 95% CI, 1.07-2.14). In NYS, no change was seen in the mean days\u2019 supply of filled hydroxyurea.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>These findings suggest that hydroxyurea was substantially underused among youths with SCA, despite establishment as the primary disease-modifying therapy for SCA, and that there was incomplete clinician or patient uptake of newly released guidelines. Results suggest that expanding use of hydroxyurea may require a multifaceted approach that includes addressing multiple system- and patient-level barriers.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.4584","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T15:04:28Z","timestamp":1679670268000},"page":"e234584","source":"Crossref","is-referenced-by-count":14,"title":["Changes in Hydroxyurea Use Among Youths Enrolled in Medicaid With Sickle Cell Anemia After 2014 Revision of Clinical Guidelines"],"prefix":"10.1001","volume":"6","author":[{"given":"Sarah L.","family":"Reeves","sequence":"first","affiliation":[{"name":"Susan B. 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Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey J.","family":"Wing","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, College of Public Health, Ohio State University, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay W.","family":"Cogan","sequence":"additional","affiliation":[{"name":"Office of Quality and Patient Safety, New York State Department of Health, Albany"},{"name":"Department of Health Policy, Management and Behavior, School of Public Health, University at Albany, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alka","family":"Goel","sequence":"additional","affiliation":[{"name":"Office of Quality and Patient Safety, New York State Department of Health, Albany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Anders","sequence":"additional","affiliation":[{"name":"Office of Quality and Patient Safety, New York State Department of Health, Albany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy S.","family":"Green","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynda D.","family":"Lisabeth","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin J.","family":"Dombkowski","sequence":"additional","affiliation":[{"name":"Susan B. 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