As survival for people with sickle cell disease (SCD) improves, fertility and family-building have become increasing priorities. This shift is especially important with the broader use of disease-modifying treatments that impact fertility. This qualitative study assessed pediatric hematologists' perspectives and practices regarding adolescents with SCD who may have fertility and family-building concerns. We interviewed 20 hematology providers about their roles, perceived barriers and facilitators, and recommendations for reproductive healthcare for adolescents with SCD. Ten participants (n = 5 men; n = 5 women; n = 5 within 5 years post-fellowship) specifically discussed fertility and family-building. We transcribed the interviews and coded them using applied thematic analysis. Three major themes emerged: the impact of disease-modifying, curative, and transformative therapies; patient-level factors that influence the timing and scope of fertility discussions; and the importance of multidisciplinary collaboration. Participants described uncertainty about the evidence surrounding fertility risks of treatments and the need to balance these with health benefits, patient age, and their care journey. Conversations about fertility and family-building in SCD are nuanced and benefit from multidisciplinary expertise. Future work should create standardized, age-based counseling and train clinic teams to address fertility concerns among adolescents with SCD.
Background: Hypertension (HTN) remains a key contributor to adverse outcomes in older adults with Alzheimer's disease (AD), which itself is the seventh leading cause of death in the U.S., affecting over 120,000 Americans annually. The co-existence of these conditions significantly increases the risk of morbidity and mortality, and despite their strong relationship, long-term mortality trends accounting for both conditions have not been assessed. This study examines trends and disparities in AD mortality among older patients (aged >= 65 years) with HTN in the U.S. from 1999 to 2023. Methods: Mortality records of older patients listing AD as the primary cause of death and HTN as a contributing cause were evaluated from 1999 to 2023 using the CDC WONDER database. Age-adjusted mortality rates (AAMRs) were computed per 100,000 population, and annual percent changes (APCs) were derived to assess temporal trends across different demographics and geographies. Results: Overall, 314,914 mortalities were attributed to AD in patients with HTN, with overall AAMRs increasing from 1999 (7.1) to 2023 (41.1). Females (AAMR: 31.6) experienced higher rates than males (AAMR: 20.7). Rates peaked among NH African Americans (AAMR: 31.8), followed by NH Whites (AAMR: 28.3) and Hispanics (AAMR: 22.3). Adults aged 85 + years (AAMR: 142.3) had higher rates compared with those aged 75-84 (AAMR: 25.1) and 65-74 years (AAMR: 2.5). Geographically, AAMRs were highest in the West region (AAMR: 31.5) and among non-metropolitan residents (AAMR: 27.9) compared to metropolitan residents (AAMR: 25.03). Trend analysis revealed statistically significant APCs (p < 0.05) across all evaluated demographic and geographic subgroups. Conclusion: This sharp, six-fold rise in AD and HTN-related mortality highlights a compounding public health challenge. The significant disparities observed in the disproportionate burden on females, NH African Americans, and non-metropolitan residents likely reflect intersecting biological vulnerabilities and structural inequities in healthcare access. These findings stress the urgent need for targeted health policy strategies and the proactive clinical management of comorbid conditions to protect these high-risk populations.
