Top 5 Takeaways

  1. In 2019, less than half of Medicaid enrollees aged 2–16 with Sickle Cell Anemia (SCA) received recommended transcranial Doppler (TCD) screening, crucial for stroke risk identification.
  2. Hydroxyurea use, effective in reducing SCA complications, was underutilized, with less than half of children aged 2–9 years and about half of those aged 10–16 years receiving it.
  3. There was an increase in TCD screening and hydroxyurea use between 2014–2019, but overall usage remained low, especially among certain age groups.
  4. The use of both TCD screening and hydroxyurea was higher in children and adolescents with severe SCA and higher levels of health care utilization.
  5. Racial disparities, socioeconomic factors, and healthcare access issues contribute to the underutilization of these critical health measures in SCA management.

Original Article Author and Citation

Corresponding Author

Laura A. Schieve,  .

Suggested Citation

Schieve LA, Simmons GM, Payne AB, et al. Use of Recommended Health Care Measures to Prevent Selected Complications of Sickle Cell Anemia in Children and Adolescents — Selected U.S. States, 2019. MMWR Morb Mortal Wkly Rep 2022;71:1241–1246. DOI: .


The study highlights the underutilization of key health measures in children and adolescents with SCA. Despite recommendations for annual TCD screening and hydroxyurea therapy, less than half of the studied group received these interventions. The study underscores the need for improved healthcare strategies and addresses barriers like racial disparities and limited access to specialized care.


The study analyzed data from the IBM MarketScan Multi-State Medicaid Database, focusing on TCD screening and hydroxyurea use among 3,352 children and adolescents with SCA, enrolled in Medicaid during 2019. The study assessed changes over time and variations by health subgroups.


The findings suggest a need for enhanced healthcare strategies to increase the use of TCD screening and hydroxyurea. The study also points to the importance of addressing systemic issues such as racism and healthcare disparities, which significantly impact the management of SCA.


Despite some progress, the use of recommended TCD screening and hydroxyurea therapy remains low among children and adolescents with SCA. To improve health outcomes, it’s crucial to implement quality care strategies, address barriers to care, and tackle the underlying issues of racial disparities and healthcare access.


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