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Are children with sickle cell disease at particular risk from the harmful effects of air pollution? Evidence from a large, urban/peri-urban cohort.
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  • Paul E. George,
  • Alexander Maillis N,
  • Yijing Zhu,
  • Yang Liu,
  • Peter Lane,
  • Wilbur Lam,
  • Joseph Lipscomb,
  • Stefanie Ebelt
Paul E. George
Emory University Department of Pediatrics

Corresponding Author:[email protected]

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Alexander Maillis N
Children's Healthcare of Atlanta Inc Aflac Cancer and Blood Disorders Center
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Yijing Zhu
Emory University School of Public Health
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Yang Liu
Emory University School of Public Health
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Peter Lane
Emory University Department of Pediatrics
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Wilbur Lam
Emory University Department of Pediatrics
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Joseph Lipscomb
Emory University Department of Health Policy and Management
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Stefanie Ebelt
Emory University School of Public Health
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Introduction Pathophysiologic pathways of sickle cell disease (SCD) and air pollution involve inflammation, oxidative stress, and endothelial damage. It is therefore plausible that children with SCD are especially prone to air pollution’s harmful effects. Methods Patient data were collected from a single center, urban/peri-urban cohort of children with confirmed SCD. Daily ambient concentrations of particulate matter (PM 2.5) were collected via satellite-derived remote-sensing technology, and carbon monoxide (CO), nitrogen dioxide (NO 2), and ozone from local monitoring stations. We used multivariable regression to quantify associations of pollutant levels and daily counts of emergency department (ED) visits, accounting for weather and time trends. For comparison, we quantified the associations of pollutant levels with daily all-patient (non-SCD) ED visits to our center. Results From 2010-2018, there were 17 731 ED visits by 1740 children with SCD (64.8% HbSS/HbSβ 0). Vaso-occlusive events (57.8%), respiratory illness (17.1%), and fever (16.1%) were the most common visit diagnoses. Three-day (lags 0-2) rolling mean PM 2.5 and CO levels were associated with daily ED visits among those with SCD (PM 2.5 incident rate ratio (IRR) 1.051 (95% CI 1.010-1.094) per 9.4 µg/m 3 increase; CO 1.088 (1.045-1.132) per 0.5 ppm). NO 2 showed positive associations in secondary analyses; ozone levels were not associated with ED visits. The comparison, all-patient ED visit analyses showed lower IRR for all pollutants. Conclusions Our results suggest short-term air pollution levels as triggers for SCD events and that children with SCD may be more vulnerable to air pollution than those without SCD. Targeted pollution-avoidance strategies could have significant clinical benefits in this population.
24 Jan 2023Submission Checks Completed
24 Jan 2023Assigned to Editor
24 Jan 2023Submitted to Pediatric Blood & Cancer
24 Jan 2023Review(s) Completed, Editorial Evaluation Pending
24 Jan 2023Reviewer(s) Assigned
14 Feb 2023Editorial Decision: Revise Minor
09 May 2023Submission Checks Completed
09 May 2023Assigned to Editor
09 May 20231st Revision Received
09 May 2023Review(s) Completed, Editorial Evaluation Pending
09 May 2023Editorial Decision: Accept