Weather-Related Exposures and Emergency Department Visits for Pediatric Sickle Cell Complications

Abstract

Objective: – Sickle cell disease (SCD) is an inherited disorder that leads to significant morbidity from health complications beginning in childhood. Weather-related factors may influence the frequency of SCD complications, but evidence regarding the impact of weather changes in the pediatric population remains limited. Our objective was to determine the association between weather-related exposures and odds of emergency department (ED) visits for acute complications in youth with SCD. Methods: – We conducted a retrospective case-crossover study of ED encounters among patients aged 0 to 21 years at 40 US children’s hospitals (2015-2020). ED visits for vaso-occlusive crisis (VOC) and/or acute chest syndrome (ACS) were included. Patients were categorized as low-risk or high risk based on the number of ED visits in the preceding year. We constructed single-variable conditional logistic regression models to identify the odds of ED visit in association with weather-related exposures of temperature, heat index (HI), and wet bulb globe temperature (WBGT). Results: – Among 48, 885 ED encounters for VOC and ACS in high-risk patients, increases in temperature, HI, and WBGT on lag day 3 were associated with increased odds of ED visits for VOC. Increases in these variables were associated with decreased odds of ED visits for ACS. No significant associations were found for low-risk patients. Conclusions: – Increased temperature, HI, and WBGT among high-risk pediatric patients with SCD were associated with increased odds of ED visit for VOC and decreased odds for ACS. As climate change progresses, further studies are needed to identify population, neighborhood, and patient-level environmental risk factors contributing to acute complications for patients with SCD.