Faculty Bibliography

INTRODUCTION/BACKGROUND:Elevated concentrations of air pollutants in residential neighborhoods are associated with poorer survival, cognitive, and cardiovascular health among older adults. Older kidney transplant (KT) recipients may be more vulnerable due to chronic immunosuppression and age-related co-morbidities. Therefore, we quantified the associations between pollutant concentrations and post-KT outcomes among older recipients. METHODS:]) were obtained from the Center for Air, Climate and Energy Solutions, and matched by ZIP code and year of KT. We used shared frailty models (cluster = state) to estimate the adjusted hazard ratios (aHR) of mortality and death-censored graft failure (DCGF) and competing risk models with cluster-robust standard errors to estimate the adjusted subhazard ratios (aSHR) of dementia and stroke by pollutant concentrations. RESULTS:concentrations were associated with a 3% (aSHR = 1.03, 95% CI: 1.00-1.07) and 4% higher risk of stroke (aSHR = 1.04, 95% CI: 1.02-1.07), respectively. CONCLUSION/CONCLUSIONS:Residence in neighborhoods with high concentrations of ambient air pollutants can worsen patient and graft survival, as well as increase the risk of stroke among older KT recipients. Early screening and interventions targeting older recipients living in such neighborhoods may be crucial for preserving cognitive and cerebrovascular health, as well as improving longitudinal quality of life.

RATIONALE & OBJECTIVE/UNASSIGNED:exposure and mortality, overall and by race and ethnicity. STUDY DESIGN/UNASSIGNED:Cohort study (2003-2019). SETTING & PARTICIPANTS/UNASSIGNED:National registry for patients with kidney failure. EXPOSURES/UNASSIGNED:), segregation scores (Theil's H method), deprivation scores (American Community Survey), and built environment factors (medically underserved areas [MUA] and urbanicity) by patients' residential ZIP code at dialysis initiation. OUTCOME/UNASSIGNED:All-cause mortality. ANALYTICAL APPROACH/UNASSIGNED:and mortality, overall and stratified by race and ethnicity. RESULTS/UNASSIGNED:< 0.001]). LIMITATIONS/UNASSIGNED:may not reflect individual-level exposures. CONCLUSIONS/UNASSIGNED:and reduce related mortality.

BACKGROUND/UNASSIGNED:; environmental injustice) by racial/ethnic segregation (social injustice) on dementia diagnosis in ESKD. METHODS/UNASSIGNED:concentrations (annualized and matched to older adults' residential ZIP code at dialysis initiation) and by segregation scores (Theil's H method). FINDINGS/UNASSIGNED:and segregation. INTERPRETATION/UNASSIGNED:experienced an increased risk of dementia; this risk was particularly pronounced among individuals in high segregation and predominantly minority neighborhoods. Environmental and social injustices likely drive racial and ethnic disparities in dementia for older adults with ESKD, underscoring the need for interventions and policies to mitigate these injustices. FUNDING/UNASSIGNED:National Institutes of Health.

BACKGROUND:on dementia may be more severe in this population. METHODS:and dementia risk factors using a Wald test. Models were adjusted for confounders, including social determinants of health. RESULTS:was associated with 1.90-fold higher odds of global cognitive impairment (95% CI: 1.48-2.46), and 3.29-fold higher risk of dementia (95% CI: 1.14-9.55). CONCLUSION/CONCLUSIONS:neighborhoods should discuss cognitive assessments and ways to increase physical activity with providers.

RATIONALE/BACKGROUND:Abrupt air quality improvements have followed the closure or dramatic emission control of large air pollution sources. These "natural experiments" provide ideal opportunities to assess the real-world health benefits of air quality improvements. The shutdown of the Shenango coking plant, a significant fossil-fuel pollution source located on an island in the Ohio River near Pittsburgh, PA, presented such an opportunity to test for changes in respiratory health in the local community following the closure. OBJECTIVES/OBJECTIVE:To identify and quantify the immediate and/or longer-term changes in respiratory hospitalizations and emergency department (ED) visits among the population residing near the Shenango coke plant at the time of its closure. METHODS:We acquired data for respiratory hospitalizations and ED visit counts by residents living in zip codes surrounding the plant, as well as at comparison control sites, three years before and after the shutdown date. The immediate and longer-term changes of respiratory health outcomes were tested with an interrupted time series model, and compared with external control sites and internal control outcomes. MEASUREMENTS AND MAIN RESULTS/RESULTS:We found the closure of the Shenango plant was associated with an immediate 20.5% (95% CI: 12.8%-27.6%) decrease for weekly respiratory ED visits, and an immediate 41.2% (95% CI: 14.4%-59.9%) decrease in pediatric asthma ED visits, followed by an additional 4% per month longer-term downward trend. Longer-term reductions, as compared to pre-closure trends, were also observed for chronic obstructive pulmonary disease hospitalizations. CONCLUSIONS:Our study provides strong confirmation that reductions in fossil-fuel-related air pollution produce both short and longer-term respiratory health benefits. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

BACKGROUND:Global temperatures and extreme heat events are worsening due to climate change and have been associated with adverse health outcomes. However, studies in low- and middle-income countries (LMICs) are rare, and there has been limited research on the combined effects of heat and relative humidity despite strong physiological evidence. METHODS:We examined 340,758 cardiovascular disease (CVD) emergency department (ED) visits in Dhaka during summer months from 2014 to 2019. Meteorological data on temperature, relative humidity (RH), and precipitation were collected from the Bangladesh Meteorological Department. We fitted time-series regression models on CVD ED data to assess the effects of heat and RH, both individually and in interaction. All models were adjusted for potential time-varying confounders. RESULTS:Exposure to heat was associated with 7.9 % (95 % CI: 4.6 to 11.3 %) excess risk of CVD ED. No association was observed between RH and CVD ED. However, the effect size of heat increased linearly with increasing RH and culminated in a 6-fold increase in excess risk on the most humid days (RH ranges between 82 and 97 %) as compared to days with normal humidity (RH ranges between 34 and 69 %) [excess risk 26.7 % (20.2 to 33.7 %) vs 4.4 % (0.4 to 8.6 %)]. Results held across several sensitivity analyses. No significant risk effect differences were observed for age or sex group in stratified analyses. CONCLUSIONS:This study provides novel and alarming evidence that high RH compounds the effect of heat on cardiovascular health, which underscores the importance of considering these factors together in clinical advice and in the assessment and development of policies addressing climate change at local, regional, and global levels.

Public health can be immediately and substantially improved by policies that also mitigate climate change over the longer term. However, implementation of these policies has been slowed at least in part by doubts and lack of awareness of these health co-benefits. To address this barrier to progress, we demonstrate how an illustrative set of interventions led to environmental, health, and economic benefits, in addition to mitigating climate change. These case studies include the closure of a coal coking plant near Pittsburgh, PA, USA, which was followed by substantial immediate and longer-term reductions in respiratory and cardiovascular health conditions in the affected local community; the health and economic benefits associated with the Barcelona, Spain Superblock program and, the air quality, health, and economic benefits from air pollution initiatives implemented in China. While improvements in air pollution are among the most obvious examples of the co-benefits achievable through climate-friendly interventions, others that reduce greenhouse gas emissions, such as the sustainable food systems in Sweden, forest conservation in Tanzania, and a plant-based food program in New York City, further illustrate how such initiatives can align with better nutrition, economic gains, and improved health. We conclude that more assessments of such interventions are needed internationally to more widely document their health and climate benefits and thereby motivate greater implementation of these interventions. Now is the time to showcase how we can improve the public's health and well-being, while also protecting our planet, the only home future generations will have.

BACKGROUND:concentrations over 1998-2022 across the USA. METHODS:components with diameters below 1 μm were constrained by observations for four major components and from established scientific understanding for the other components. FINDINGS/RESULTS:ratio experienced simultaneous decrease (-0·0013 per year, p<0·0001). INTERPRETATION/CONCLUSIONS:. FUNDING/BACKGROUND:National Institute of Environmental Health Sciences, National Institutes of Health.