Singer Darrell E, Byrne Celia, Chen Ligong, Shao Stephanie, Goldsmith Jonathan, Niebuhr David W
Department of Preventive Medicine and Biostatistics, Uniformed Services of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD.
John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 4494 North Palmer Road, Bethesda, MD.
Mil Med. 2018 Jul 1;183(7-8):e310-e317. doi: 10.1093/milmed/usx085.
A number of studies have found an association between sickle cell trait (SCT) and exertional heat illnesses (EHIs) including heat stroke, a potentially fatal condition. The strength of this association varied across studies, limiting the ability to quantify potential benefits of SCT-screening policies for competitive athletics and military service members. We determined the relative rate and attributable risk of developing EHI associated with being SCT positive and the EHI health care utilization.
We conducted a retrospective cohort study among U.S. enlisted, active duty service members during 1992-2012 from the Department of Defense Military Healthcare System databases. All 15,081 SCT-positive individuals and a sample of 60,320 from those considered SCT negative were followed through 2013 for EHI outcomes ranging from mild heat illness to heat stroke.
The adjusted hazard ratio for EHI in SCT-positive compared with SCT-negative individuals was 1.24 (95% confidence interval 1.06, 1.45). Risk factors for EHI included age over 30 yr at enlistment, female gender, Marine Corps, combat occupations, and enlistment between April and June. An estimated 216 Department of Defense enlistees (95% confidence interval: 147, 370) would need to be screened to identify and potentially prevent one case of EHI. The attributable risk of EHI due to SCT was 33% (95% confidence interval 19, 45%).
Our findings suggest that SCT screening will identify approximately a third of SCT individuals at risk for EHI, but does not provide definitive evidence for universal compared with selective (e.g., occupational based) in military enlistees. A cost-effectiveness analysis is needed for policy makers to assess the overall value of universal SCT screening to prevent morbidity and mortality in both the military and the collegiate athletic populations.
多项研究发现镰状细胞性状（SCT）与包括中暑在内的劳力性热射病（EHI）之间存在关联，中暑是一种潜在的致命病症。这种关联的强度在不同研究中有所不同，限制了量化针对竞技运动员和军人的SCT筛查政策潜在益处的能力。我们确定了SCT阳性个体发生EHI的相对发生率和归因风险以及EHI的医疗保健利用率。
我们利用国防部军事医疗系统数据库，对1992年至2012年期间美国现役军人进行了一项回顾性队列研究。对所有15,081名SCT阳性个体以及60,320名被视为SCT阴性个体的样本进行随访，直至2013年，观察从轻度热射病到中暑的EHI结局。
与SCT阴性个体相比，SCT阳性个体发生EHI的校正风险比为1.24（95%置信区间1.06, 1.45）。EHI的风险因素包括入伍时年龄超过30岁、女性、海军陆战队、战斗岗位以及4月至6月入伍。估计需要对216名国防部新兵进行筛查（95%置信区间：147, 370），以识别并可能预防一例EHI。SCT导致EHI的归因风险为33%（95%置信区间19, 45%）。
我们的研究结果表明，SCT筛查将识别出约三分之一有EHI风险的SCT个体，但对于军人普遍筛查与选择性（如基于职业）筛查相比，并未提供确凿证据。政策制定者需要进行成本效益分析，以评估普遍SCT筛查对预防军人和大学运动员群体发病和死亡的总体价值。
