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Journal Article


Nelson DA, Deuster PA, O'Connor FG, Kurina LM. Am. J. Epidemiol. 2018; 187(3): 523-528.


(Copyright © 2018, Oxford University Press)






There is concern that sickle cell trait increases risk of exertional collapse, a primary cause of which is heat injury. However, no population-based studies among active individuals have addressed this, representing a critical evidence gap. We conducted a retrospective cohort study of sickle cell trait-tested African American soldiers on active-duty in the U.S. Army anytime between January 2011 and December 2014. Using Cox proportional hazards models and adjusting for demographic and medical factors, we observed no significant associations between sickle cell trait and either mild heat injury (hazard ratio (HR), 1.15; 95% confidence interval (CI): 0.84, 1.56; n = 45,999) or heat stroke (HR, 1.11; 95% CI: 0.44, 2.79; n = 46,183). Mild heat injury risk was substantially higher among soldiers with recent prescriptions for antipsychotics (HR, 3.25, 95% CI: 1.33, 7.90). Heat stroke risk was elevated among those with a prior mild heat injury (HR, 17.7; 95% CI: 8.50, 36.7) and among overweight and obese individuals (HR, 2.91; 95% CI: 1.38, 6.17 and HR, 4.04; 95% CI: 1.72, 9.45, respectively). In a setting where universal precautions are utilized to mitigate risk of exertion related illnesses, sickle cell trait is not associated with either mild heat injury or heat stroke.

Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2017.

Language: en


cohort studies; heat stroke; mild heat injury; military personnel; sickle cell trait


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