Associations between environmental factors and hospital admissions for sickle cell disease

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Title: Associations between environmental factors and hospital admissions for sickle cell disease
Authors: Piel, FB
Tewari, S
Brousse, V
Analitis, A
Font, A
Menzel, S
Chakravorty, S
Thein, SL
Inusa, B
Telfer, P
De Montalembert, M
Fuller, GW
Katsouyanni, K
Rees, DC
Item Type: Journal Article
Abstract: Sickle cell disease (SCD) is an increasing global health burden. This inherited disease is characterised by a remarkable phenotypic heterogeneity, which can only partly be explained by genetic factors. Environmental factors are likely to play an important role but studies of their impact on disease severity are limited and their results are often inconsistent. This study investigated associations between a range of environmental factors and hospital admissions of young patients with SCD in London and in Paris between 2008 and 2012. Specific analyses were conducted for sub-groups of patients with different genotypes and for the main reasons of admissions. Generalized additive models and distributed lag non-linear models were used to assess the magnitude of the associations and to calculate relative risks. Some environmental factors significantly influence the numbers of hospital admissions of children with SCD, although the associations identified are complicated. Our study suggests that meteorological factors are more likely to be associated with hospital admissions for SCD than air pollutants. It confirms previous reports of risks associated with wind speed (RR: 1.06/SD [95% confidence interval (CI): 1.00-1.12]) and also with rainfall (RR: 1.06/SD [95%CI: 1.01-1.12]). Maximum atmospheric pressure was found to be a protective factor (RR: 0.93/SD [95%CI: 0.88-0.99]). Weak or no associations were found with temperature. Divergent associations were identified for different genotypes or reasons of admissions, which could partly explain the lack of consistency in earlier studies. Advice to patients with SCD usually includes avoiding a range of environmental conditions that are believed to trigger acute complications, including extreme temperatures and high altitudes. Scientific evidence to support such advice is limited and sometimes confusing. This study shows that environmental factors do explain some of the variations in rates of admission to hospital with acute symptoms in SCD, but the associations are complex, and likely to be specific to different environments and the individual's exposure to them. Furthermore, this study highlights the need for prospective studies with large numbers of patients and standardised protocols across Europe.
Issue Date: 1-Dec-2016
Date of Acceptance: 25-Nov-2016
ISSN: 0390-6078
Publisher: Ferrata Storti Foundation
Start Page: 666
End Page: 675
Journal / Book Title: Haematologica - the Hematology Journal
Volume: 102
Copyright Statement: © 2017 Ferrata Storti Foundation Material published in Haematologica is covered by copyright. All rights are reserved to the Ferrata Storti Foundation. Use of published material is allowed under the following terms and conditions: Copies of published material are allowed for personal or internal use. Sharing published material for non-commercial purposes is subject to the following conditions:, sect. 3. Reproducing and sharing published material for commercial purposes is not allowed without permission in writing from the publisher.
Keywords: Science & Technology
Life Sciences & Biomedicine
Anemia, Sickle Cell
Child, Preschool
Disease Progression
Environmental Exposure
Middle Aged
Odds Ratio
Public Health Surveillance
Risk Factors
Young Adult
1102 Cardiovascular Medicine And Haematology
Publication Status: Published
Conference Place: Italy
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care

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