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Observational Study
. 2014 Dec;93(29):e280.
doi: 10.1097/MD.0000000000000280.

Environmental influences on daily emergency admissions in sickle-cell disease patients

Armand Mekontso Dessap  1 , Damien Contou, Claire Dandine-Roulland, François Hemery, Anoosha Habibi, Anaïs Charles-Nelson, Frederic Galacteros, Christian Brun-Buisson, Bernard Maitre, Sandrine Katsahian
Affiliations
Observational Study

Environmental influences on daily emergency admissions in sickle-cell disease patients

Armand Mekontso Dessap et al. Medicine (Baltimore). 2014 Dec.

Abstract

Previous reports have suggested a role for weather conditions and air pollution on the variability of sickle cell disease (SCD) severity, but large-scale comprehensive epidemiological studies are lacking. In order to evaluate the influence of air pollution and climatic factors on emergency hospital admissions (EHA) in SCD patients, we conducted an 8-year observational retrospective study in 22 French university hospitals in Paris conurbation, using distributed lag non-linear models, a methodology able to flexibly describe simultaneously non-linear and delayed associations, with a multivariable approach. During the 2922 days of the study, there were 17,710 EHA, with a mean daily number of 6.1 ± 2.8. Most environmental factors were significantly correlated to each other. The risk of EHA was significantly associated with higher values of nitrogen dioxide, atmospheric particulate matters, and daily mean wind speed; and with lower values of carbon monoxide, ozone, sulfur dioxide, daily temperature (minimal, maximal, mean, and range), day-to-day mean temperature change, daily bright sunshine, and occurrence of storm. There was a lag effect for 12 of 15 environmental factors influencing hospitalization rate. Multivariate analysis identified carbon monoxide, day-to-day temperature change, and mean wind speed, along with calendar factors (weekend, summer season, and year) as independent factors associated with EHA. In conclusion, most weather conditions and air pollutants assessed were correlated to each other and influenced the rate of EHA in SCD patients. In multivariate analysis, lower carbon monoxide concentrations, day-to-day mean temperature drop and higher wind speed were associated with increased risk of EHA.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Paris conurbation map with the public hospital network (H) and monitoring stations for meteorological (black circles) and air quality (white circles) data.
FIGURE 2
FIGURE 2
Overall effect with relative risk (red line) and 95% confidence interval (grey area) for associations between the number of daily emergency admissions in sickle cell disease patients and daily minimal temperature (panel A), daily maximal temperature (panel B), daily mean temperature (panel C), daily temperature range (panel D), day-to-day mean temperature change (panel E), daily relative humidity (panel F), daily bright sunshine (panel G), daily mean wind speed (panel H), daily maximal wind speed (panel I), and daily rainfall (panel J).
FIGURE 3
FIGURE 3
Overall effect with relative risk (red line) and 95% confidence interval (grey area) for associations between the number of daily emergency admissions in sickle cell disease patients and daily mean concentrations of carbon monoxide (panel A), nitrogen dioxide (panel B), ozone (panel C), atmospheric particulate matters with aerodynamic diameter smaller than 10 μm (panel D) or 2.5 μm (panel E), and sulfur dioxide (panel F). CO = carbon monoxide, NO2 = nitrogen dioxide, O3 = ozone, PM10 = atmospheric particulate matters with aerodyamic diameter smaller than 10 μm, PM2.5 = atmospheric particulate matters with aerodyamic diameter smaller than 2.5 μm, SO2 = sulfur dioxide.
FIGURE 4
FIGURE 4
Box and Whisker plots of the number of daily emergency admissions in sickle cell disease patients according to weekend (panel A), summer season (panel B), and year of the study (panel C).
See this image and copyright information in PMC

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