Extreme weather, air pollution, and stroke among an aging female population

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ABSTRACT This application is in response to the PAR-19-250: “EnvironmentalInfluences on Aging: Effects of Extreme Weatherand Disaster Events on Aging Populations .”Air pollutants are especially detrimental for aging populations; exposure to air pollution as measured by ambient particulate matter (e.g., PM2.5) has been linked to diseases that increase with age, including cardiovascular diseases (CVD) and stroke. Older women (who outnumber men 3:2) are particularly susceptible to CVD endpoints and to stroke risk in particular; stroke risk in women doubles immediately following menopause. Extreme weather events such as wildfires and prolonged drought in the last decade alone have adversely affected air pollution exposure in states such as California. A number of metropolitan counties in the state have particulate pollution levels above federal and state ambient standards, and during extreme weather events, these levels rival that of the worst cities in the world. Our overall study objective is to evaluate the intersection of extreme weather events and air pollution in an aging female population who are at increased risk for CVDs, and in particular, at peak susceptibility for stroke. In Aim1, we will evaluate the acute effects from wildfire events by ascertaining stroke events within geographically affected areas based on satellite imagery. Elevated PM2.5 exposure estimates resulting from a wildfire event in the affected areas will be associated with hospitalizations (including emergency room visits) from stroke and CVD. In Aim 2, we will determine the role of specific PM2.5 components in stroke risk and mortality. Employing complementary satellite- and source-based approaches, we will identify key sources of PM2.5 and its chemical constituents that are attributable to stroke. Leveraging 25-years of follow-up from the study population, this aim will permit us to delineate components of air pollution from drought and wildfire events versus other (e.g., transportation, industrial) exposures. For both aims, select CVD endpoints (e.g., myocardial infarction) will also be explored. In Aim 3, we will evaluate the association between PM2.5 exposure with serum immune markers among 2000 participants whose exposures reflect a cross-section of exposure during the 2015 drought and wildfire season. This aim will inform the purported biologic underpinning for stroke and CVD risk, by key PM2.5 sources and constituents. To successfully accomplish these aims, we will leverage longitudinal data from the California Teachers Study, a geographically-defined population-based cohort study of 133,479 women whose 25 year follow-up spans: (a) key periods of stroke and CVD susceptibility in women, and (b) elevated levels of air pollution exposure in California where there have been prolonged periods of drought and numerous wildfires.