Are children with sickle cell disease at particular risk from the harmful effects of air pollution? Evidence from a large, urban/peri-urban cohort.
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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患有镰状细胞病的儿童是否特别容易受到空气污染的有害影响？
DOI：
10.1002/pbc.30453
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发表时间：
2023
影响因子：
3.2
通讯作者：
Ebelt,Stefanie
中科院分区：
文献类型：
--
作者：
George,PaulE;Maillis,Alexander;Zhu,Yijing;Liu,Yang;Lane,PeterA;Lam,Wilbur;Lipscomb,Joseph;Ebelt,Stefanie
简介镰状细胞病 (SCD) 和空气污染的病理生理途径涉及炎症、氧化应激和内皮损伤。因此，患有 SCD 的儿童似乎特别容易受到空气污染的有害影响。方法从单中心、城市/城郊确诊患有 SCD 的儿童队列中收集患者数据。通过卫星遥感技术收集每日环境颗粒物 (PM2.5) 浓度，并从当地监测站收集一氧化碳 (CO)、二氧化氮 (NO2) 和臭氧。我们利用多变量回归来量化污染物水平与每日急诊科 (ED) 就诊次数之间的关联，并考虑到天气和时间趋势。为了进行比较，我们量化了污染物水平与每天到我们中心的所有患者（非 SCD）急诊就诊的关联。结果从 2010 年到 2018 年，1740 名 SCD 儿童（64.8% HbSS/HbSβ0）共进行了 17,731 次急诊就诊。血管闭塞事件（57.8%）、呼吸系统疾病（17.1%）和发烧（16.1%）是最常见的就诊诊断。较高的 3 天（滞后 0-2）滚动平均 PM2.5 和 CO 水平与 SCD 患者每日急诊就诊相关（每增加 9.4 µg/m3，PM2.5 发病率 [IRR] 1.051 [95% 置信区间：1.010–1.094]；CO 每增加 0.5 ppm 1.088 [1.045–1.132]）。 NO2 在二次分析中显示出正相关；臭氧水平与急诊就诊无关。相比之下，所有患者的急诊就诊分析显示所有污染物的 IRR 较低。结论我们的结果表明短期空气污染水平是 SCD 事件的触发因素，并且患有 SCD 的儿童可能比没有 SCD 的儿童更容易受到空气污染的影响。有针对性的避免污染策略可能会对这一人群产生显着的临床益处。
IntroductionPathophysiologic 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.MethodsPatient data were collected from a single‐center, urban/peri‐urban cohort of children with confirmed SCD. Daily ambient concentrations of particulate matter (PM2.5) were collected via satellite‐derived remote‐sensing technology, and carbon monoxide (CO), nitrogen dioxide (NO2), 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.ResultsFrom 2010 to 2018, there were 17,731 ED visits by 1740 children with SCD (64.8% HbSS/HbSβ0). Vaso‐occlusive events (57.8%), respiratory illness (17.1%), and fever (16.1%) were the most common visit diagnoses. Higher 3‐day (lags 0–2) rolling mean PM2.5and CO levels were associated with daily ED visits among those with SCD (PM2.5incident rate ratio [IRR] 1.051 [95% confidence interval: 1.010–1.094] per 9.4 μg/m3increase; CO 1.088 [1.045–1.132] per 0.5 ppm). NO2showed 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.ConclusionsOur 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.