Impact of ambient air pollution on sickle cell disease exacerbations in Atlanta, GA Public

Abstract

Abstract

Impact of ambient air pollution on sickle cell disease exacerbations in Atlanta, Georgia

By Amelia H. Blumberg

Background

Approximately 100,000 Americans are affected by sickle cell disease (SCD) with varying symptoms and several risk factors. The cause of such symptom variability is not known, although the environment may play a considerable role. The recurrent vaso-occlusive painful crises that people with SCD experience are the main reason they go to the emergency department (ED). Research on the role of environmental factors, such as air pollution, in sickle cell disease is limited however.

Objective

Given the limited prior research, we sought to assess if daily ambient air pollution concentrations are associated with acute sickle cell disease exacerbations in Atlanta, Georgia, using ED visit data for SCD exacerbations over a 15-year (1998-2013) period. Furthermore, we assessed potential heterogeneity of associations by age and sex.

Methods

ED visit data were from 41 of 42 hospitals in the 20-county Atlanta, GA area. Air pollution data were from the Jefferson Street monitoring site, which provided daily information for 12 air pollutants of interest: carbon monoxide (CO), nitrogen dioxide (NO2), nitrogen oxides (NOx), ozone (O3), sulfur dioxide (SO2), particulate matter less than 10 µm and less than 2.5 µm in aerodynamic diameter (PM10 and PM2.5, respectively), sulfate (SO4^2-), nitrate (NO3^-), ammonium (NH4⁺), elemental carbon (EC), and organic carbon (OC). Associations of daily air pollution levels and counts of sickle cell disease related ED visits were estimated using Poisson models.

Results

For 1998-2013, associations of air pollutants and sickle cell ED visits were generally consistent with the null. For the later period (2005-2013), however, we observed statistically significant positive associations between traffic pollutants (CO, NOx, EC) and SCD ED visits [e.g., rate ratio of 1.022 (95% CI: 1.002, 1.043) per interquartile range increase in CO]. In the later period, analyses stratified by age groups indicated stronger associations with these traffic pollutants among children (0-18 years) than older age groups.

Conclusion

This work highlights that traffic pollutants in particular may affect the number of ED visits for sickle cell disease exacerbations for children (ages 0-18 years) in Atlanta, GA.

Table of Contents

Table of Contents

A. Introduction.............................................................1

B. Methods..................................................................6

C. Results....................................................................9

D. Discussion..............................................................13

E. Tables and Figures...................................................20

F. References..............................................................28

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Environmental Health Health Sciences, Epidemiology
Mot-clé	air pollution sickle cell disease exacerbations sickle cell disease
Committee Chair / Thesis Advisor	Sarnat, Stefanie Ebelt, Emory University Sarnat, Jeremy, Emory University
Committee Members	Tolbert, Paige, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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