Air Pollution and Environmental Injustice Are Related to Respiratory Complications in Individuals With Sickle Cell Disease

Sickle cell disease (SCD) is a genetically inherited blood disorder affecting people of African descent. SCD is characterized by painful episodes and an acute lung injury known as acute chest syndrome (ACS). Patients with SCD have a life expectancy <19 years compared to Blacks without SCD. There is minimal research investigating air pollution and health complications in SCD. The aims of this research were to investigate whether pulmonary function is affected by exposure to ambient air pollution, whether higher air pollution concentrations are associated with hospitalizations for ACS, and whether environmental injustice impacts the respiratory health of children and young adults with SCD. Air pollution data on the criteria air pollutants (CAPs) was obtained from the US Environmental Protection Agency (EPA). Patient health data were obtained from Children’s Hospital of Alabama electronic medical records. Logistic regression, distributed lag non-linear regression, Granger Causality, and Getis-Ord Gi* hot spot analysis were used to analyze our data. The EPA’s EJScreen tool was used as a measure of exposure to environmental injustice. ArcGIS was used to map the EJScreen data. Exposure to short-term air pollution is significantly associated with a reduction in pulmonary function in children and young adults with SCD. Children and young adults exposed to a one-unit increase in the monthly average concentrations of sulfur dioxide (SO₂) experienced an increase in the odds of having abnormal pulmonary function. We observed the trends of each criteria air pollutant in our study to be closely aligned with the trends in the hospitalizations for ACS. Most of our study participants with a history of ACS lived in areas burdened by greater environmental injustices. Specifically, the hot spots for ACS overlapped with the hot spots for PM_2.5. Unequal exposure to environmental injustices leads to increases in hospitalizations for respiratory complications in individuals with SCD. Reductions in air pollution could be greatly beneficial to the pulmonary function and overall respiratory health of individuals with SCD. Further research is needed to examine associations between air pollution and hospitalizations for ACS in individuals with SCD.