Short-term exposures to higher temperature and heat waves have been associated with adverse acute cardiovascular and respiratory mortality, but less is known about the chronic effects of weather. We propose to evaluate the chronic adverse health risks associated with long-term exposure to fluctuations in the weather parameters in persons aged over 64 years on a national scale, focusing on mortality in all Medicare enrollees, and in subjects with specific cardiovascular and neurological conditions. We will identify how the health risks changed over the years, and use this information to make predictions of how the risks will change under different climate scenarios. In a recent paper we showed that long-term exposure to high day-to-day variability in summer temperatures (defined as the standard deviation of daily levels of summer temperature) might elevate the risk of mortality in different subgroups of susceptible populations of elderly1. In this project we will partner with the Atmospheric Chemistry Modeling Group at Harvard: (1) to estimate the chronic effects associated with long-term exposure to higher day-to-day variability in temperature and in water vapor pressure (WVP) within summer months (June-August) on mortality in all Medicare enrollees;(2) to examine the chronic effects on mortality in subject with specific conditions such as cardiovascular and neurological disease;(3) to identify characteristics of city (e.g. socio-economic status, percent of green space climate zone, population in poverty, percent of population by race, air conditioning prevalence) which modify the risk of dying. Specifically, we will identify whether changes in weather related risk over time and space are associated to changes in urban structure, air conditioning prevalence, and socioeconomic status both within city and across cities, and whether differences in sensitivity to weather variability across locations are related to green space and population characteristics. Importantly, these city level characteristics will be defined on the zip-code level, not the city level, allowing us to capture te impact of true local land use. (4) Finally, we will predict how life expectancy will change with increasing variability of summertime temperatures in a future atmosphere. An innovative aspect of our investigation is that we will focus on less explored weather parameters such as variability in temperature and variability in WVP. We will analyze the data using novel statistical methods (survival models with time-varying factors and meta-regression models). The findings of this national analysis will advance statistical analyses of climate change data and knowledge of the impacts of temperature and humidity variability on life expectancy. By producing results that can be extrapolated to the future, by identifying the covariates that explain the differences in temperature related mortality over time and across cities, we will identify key factors important for adaptation and mitigation strategies. Results of our study will aid NIH by identifying specific cardiovascular disease that might exacerbate risk, which will lead to targeted and cost effective interventions.

Public Health Relevance

This project will quantify the chronic effects associated with long-term exposure to day-to-day variability in summer temperature and water vapor pressure, and by estimating changes in weather related mortality risks over the years we will identify how much people adapt. We will also identify whether changes in survival over time and space are related to changes in area level characteristics and individual level characteristics;finally we wll project health consequences of increasing variability of summertime temperatures under different future scenarios of climate change.

National Institute of Health (NIH)
National Institute of Environmental Health Sciences (NIEHS)
Exploratory/Developmental Grants (R21)
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Cardiovascular and Sleep Epidemiology (CASE)
Program Officer
Dilworth, Caroline H
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Harvard University
Public Health & Prev Medicine
Schools of Public Health
United States
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Di, Qian; Rowland, Sebastian; Koutrakis, Petros et al. (2017) A hybrid model for spatially and temporally resolved ozone exposures in the continental United States. J Air Waste Manag Assoc 67:39-52
Jhun, Iny; Mata, Douglas A; Nordio, Francesco et al. (2017) Ambient Temperature and Sudden Infant Death Syndrome in the United States. Epidemiology 28:728-734
Wang, Yan; Shi, Liuhua; Lee, Mihye et al. (2017) Long-term Exposure to PM2.5 and Mortality Among Older Adults in the Southeastern US. Epidemiology 28:207-214
Bravo, Mercedes A; Ebisu, Keita; Dominici, Francesca et al. (2017) Airborne Fine Particles and Risk of Hospital Admissions for Understudied Populations: Effects by Urbanicity and Short-Term Cumulative Exposures in 708 U.S. Counties. Environ Health Perspect 125:594-601
Makar, Maggie; Antonelli, Joseph; Di, Qian et al. (2017) Estimating the Causal Effect of Low Levels of Fine Particulate Matter on Hospitalization. Epidemiology 28:627-634
Di, Qian; Dai, Lingzhen; Wang, Yun et al. (2017) Association of Short-term Exposure to Air Pollution With Mortality in Older Adults. JAMA 318:2446-2456
Di, Qian; Wang, Yan; Zanobetti, Antonella et al. (2017) Air Pollution and Mortality in the Medicare Population. N Engl J Med 376:2513-2522
Zanobetti, Antonella; Coull, Brent A; Kloog, Itai et al. (2017) Fine-scale spatial and temporal variation in temperature and arrhythmia episodes in the VA Normative Aging Study. J Air Waste Manag Assoc 67:96-104
Wang, Yan; Bobb, Jennifer F; Papi, Bianca et al. (2016) Heat stroke admissions during heat waves in 1,916 US counties for the period from 1999 to 2010 and their effect modifiers. Environ Health 15:83
Kioumourtzoglou, Marianthi-Anna; Schwartz, Joel; James, Peter et al. (2016) PM2.5 and Mortality in 207 US Cities: Modification by Temperature and City Characteristics. Epidemiology 27:221-7

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