Ambient air pollution and sickle cell disease- related emergency department visits in Atlanta, GA

• Type of Material: Article
• Authors: Amelia H Blumberg, Emory University; Stefanie Ebelt, Emory University; Donghai Liang, Emory University; Claudia Morris, Emory University; Jeremy Sarnat, Emory University
• Language: English
• Date: 2020-05-01
• Publisher: ACADEMIC PRESS INC ELSEVIER SCIENCE
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.envres.2020.109292
• Title of Journal or Parent Work: ENVIRONMENTAL RESEARCH
• Volume: 184
• Start Page: 109292
• End Page: 109292
• Grant/Funding Information: This research was made possible by grants to Emory University from the US Environmental Protection Agency (USEPA; R82921301), the National Institute of Environmental Health Sciences (R01ES11294), and the Electric Power Research Institute (EP-P27723/C13172 and EP-P4353/C2124). Research reported in this publication was also supported by the National Institutes of Health-National Center for Complementary and Integrative Health grant K24AT009893 (to CRM). The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the USEPA. Further, USEPA does not endorse the purchase of any commercial products or services mentioned in the publication.
• Keywords: EXPOSURE; Public, Environmental & Occupational Health; ARGININE METABOLOME; PULMONARY-HYPERTENSION; NITRIC-OXIDE; Life Sciences & Biomedicine; Air pollution; Acute health effects; ASSOCIATIONS; ENDOTHELIAL DYSFUNCTION; Science & Technology; Emergency department visits; CHILDREN; HOSPITAL ADMISSIONS; Environmental Sciences; ACUTE PAIN; Sickle cell disease; ASTHMA; Environmental Sciences & Ecology

Abstract

Background: Sickle cell disease (SCD) is an inherited, autosomal recessive blood disorder, among the most prevalent genetic diseases, globally. While the genetic and hemolytic dynamics of SCD have been well-characterized, the etiology of SCD-related pathophysiological processes is unclear. Although limited, observational evidence suggests that environmental factors, including urban air pollution, may play a role. Objectives: We assessed whether daily ambient air pollution concentrations are associated with corresponding emergency department (ED) visit counts for acute SCD exacerbations in Atlanta, Georgia, during a 9-year (2005–2013) period. We also examined heterogeneity in response by age and sex. Methods: ED visit data were from 41 hospitals in the 20-county Atlanta, GA area. Associations between daily air pollution levels for 8 urban air pollutants and counts of SCD related ED visits were estimated using Poisson generalized linear models. Results: We observed positive associations between pollutants generally indicative of traffic emissions and corresponding SCD ED visits [e.g., rate ratio of 1.022 (95% CI: 1.002, 1.043) per interquartile range increase in carbon monoxide]. Age stratified analyses indicated stronger associations with traffic pollutants among children (0–18 years), as compared to older age strata. Associations involving other pollutants, including ozone and particulate matter and for models of individuals >18 years old, were consistent a null hypothesis of no association. Discussion: This analysis represents the first North American study to examine acute risk among individuals with SCD to urban air pollution and provide evidence of urban air pollution, especially from traffic sources, as a trigger for acute exacerbations. These findings are consistent with a hypothesis that biological pathways, including several centrally associated with oxidative stress, may contribute towards enhanced susceptibility in individuals with SCD.