Abstract
AimAplastic anemia (AA) affects the Asian population two to three fold more than people in other regions. Besides the host genetics and socioeconomic status, several other environmental exposures have been linked with an AA etiology. We aimed to examine the association of various environmental exposures with AA occurrence among Pakistani individuals.Subjects and methodsA case-control study was conducted in Karachi, Pakistan, where cases (diagnosed AA patients) were selected from the National Institute of Blood Disease and Bone Marrow Transplantation (NIBD), while for each case, a single control (who was free of AA and visited the outpatient department of the same hospital for the treatment of minor ailments) was selected matched by age and sex. A total of 428 participants were included in this study with equal proportions of cases and controls. Information related to disease characteristics, sociodemographics and exposure to chemicals was collected through a survey questionnaire, laboratory investigations and medical records. Descriptive results were reported as frequencies and proportions, adjusted odds ratios with 95 % confidence intervals and population attributable risk (PAR) as percentage.ResultsAmong study participants (n = 428), AA was significantly associated with various environmental exposures. Participants residing in rural settings (OR = 2.29, 95 % CI 1.12–4.67, p-value < 0.01) and those who reported exposure to pesticides (OR = 3.58, 95 % CI 1.27–10.10, p-value 0.01; PAR = 18.16 %) were significantly more likely to report AA. Participants with a formal education were significantly less likely to have AA (OR = 0.27, 95 % CI 0.10–0.71, p-value < 0.01).ConclusionsThis study observed a significant association of aplastic anemia with a lower socioeconomic profile, and certain environmental exposures among the Pakistani population. The evidence may be helpful in understanding the pathophysiology of aplastic anemia in the context of environmental exposures.
Highlights
Aplastic anemia (AA) is defined as Bbone marrow hypoplasia or aplasia resulting in pancytopenia^; it affects 2–7 million individuals globally (Shadduck 1995; Young and Kaufman 2008)
Among the various chemicals suspected of an etiological association with AA, pesticides, arsenic and benzene have been found to be strongly linked with an increased susceptibility of individuals to develop AA (Beelte et al 2009; Chatterjee et al 2014; Fleming and Timmeny 1993; Morton and Dunnette 1994; Peremarti et al 2014; Prihartono et al 2011)
The findings of this study indicate that AA is associated with a lower socioeconomic profile and environmental exposure to several toxic substances among the Pakistani population
Summary
Aplastic anemia (AA) is defined as Bbone marrow hypoplasia or aplasia resulting in pancytopenia^; it affects 2–7 million individuals globally (Shadduck 1995; Young and Kaufman 2008). Wide variation in the prevalence of AA has been observed (Young and Kaufman 2008). Individuals in Asian countries are affected two to three fold more than populations from other regions (Kojima 2002; Mary et al 1990; Young and Kaufman 2008). Scientific evidence suggests that the wide variation in the prevalence of AA among different regions of the world could be due to variations in environmental exposures Asian residents in other regions, for instance, have experienced AA at a rate native to the region of immigration, which favors the environmental predisposition more than the genetic one (Young and Kaufman 2008). Very few risk factors have been identified, and risk of disease development is mostly linked with the host genetics (Young and Kaufman 2008). Among the various chemicals suspected of an etiological association with AA, pesticides, arsenic and benzene have been found to be strongly linked with an increased susceptibility of individuals to develop AA (Beelte et al 2009; Chatterjee et al 2014; Fleming and Timmeny 1993; Morton and Dunnette 1994; Peremarti et al 2014; Prihartono et al 2011)
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