Susceptibility and adverse health outcomes related to climate-sensitive events among older Medicare beneficiaries with Alzheimer and Dementia

患有阿尔茨海默症和痴呆症的老年医疗保险受益人与气候敏感事件相关的易感性和不良健康结果

• 批准号: 10607424
• 负责人: Michelle L Bell
• 金额: $ 237.85万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-15 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10607424
• 关键词: Address; Affect; Age; Aging; Air Pollutants; Air Pollution; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Area; Burn injury; Charge; Chronic; Climate; Code; Computer software; Data; Dementia; Dependence; Development; Elderly; Emergency Situation; Environmental Impact; Ethnic Origin; Event; Exposure to; Frequencies; Future; Goals; Health; Heat Waves; Hispanic Americans; Home; Hospitalization; Hospitals; Imagery; Individual; Knowledge; Late Onset Alzheimer Disease; Link; Literature; Machine Learning; Medicare; Methodology; Methods; Modeling; Monitor; Nitrogen Dioxide; Nursing Homes; Outcome; Ozone; Patient-Focused Outcomes; Persons; Physiological; Population; Predisposition; Public Health; Race; Racial Segregation; Readiness; Recovery; Regulation; Reporting; Research; Risk Estimate; Science; Series; Smoke; Socioeconomic Status; Statistical Data Interpretation; Subgroup; Symptoms; Time; Vulnerable Populations; Weather; Wildfire; Work; World Health Organization; beneficiary; brain health; climate change; climate impact; cohort; community-level factor; design; effective intervention; environmental health disparity; environmental justice; extreme heat; extreme temperature; fine particles; frailty; health management; hospital readmission; land use; loved ones; machine learning algorithm; meteorological data; mortality; mortality risk; multiple chronic conditions; novel; response; sex; spatiotemporal; structural determinants

The WHO listed air pollution and climate change as two of the top ten threats in 2019, and earlier research indicates links between climate change exposures and brain health. Further, the burden of older persons with Alzheimer’s disease (AD) and related dementias (ADRD) is expected to double by 2060, with the largest increase for Hispanic Americans. Simultaneously, wildfires are increasing in frequency, intensity, and duration. In summary, the environmental impact of climate change could become a brain health emergency that we are unprepared to tackle. To date, little is known regarding impacts of heat or air pollution, including wildfire smoke, on the elderly with AD/ADRD. Most studies on climate change related vulnerability investigated a single factor at a time rather than the real-world settings characterized by multiple factors (co-occurring air pollution and heat, socio-economic status, frailty, chronic conditions, race/ethnicity). Further, previous studies have not leveraged recent developments in satellite imagery, machine learning, and causal inference methods, which can increase the rigor and validity of statistical analysis. We propose to address these scientific gaps using a large, validated cohort of US Medicare beneficiaries (>65y) with AD/ADRD (approx. 10 million for the period 2000-2019) and spatially resolved weather data combined with state-of-the-science machine learning for estimates of air pollution exposure, which leverages satellite imagery, land use data, and monitors. Our long- term goals are to characterize the vulnerability and health impacts of climate change-related exposures within a large cohort of older adults with AD/ADRD. First, we will estimate the impacts of short-term exposure to heat and heatwaves on cause-specific hospital admissions, readmissions, mortality, and a novel patient-centered outcomes of days-at-home, and develop machine learning algorithms to identify which subpopulations with AD/ADRD are most vulnerable with respect to several individual- and community-level factors (e.g., sex, chronic conditions, race/ethnicity, frailty). Next, we will estimate vulnerability of older persons with AD/ADRD to air pollution including wildfire smoke using our state-of-the-science approach to estimate air pollution and wildfire smoke exposure. We then estimate the impacts and vulnerabilities from co-occurring heat and air pollution (including heat waves and wildfire smoke) by developing Bayesian hierarchical spatio-temporal models to quantify synergistic effects. Finally, we will disseminate all methods, exposure data, and statistical software, making them publicly available free of charge. Characterizing the factors that increase vulnerability for older persons with AD/ADRD will allow decisionmakers to design effective interventions. Findings will inform impact assessments of climate change, which is anticipated to increase heat and air pollution including wildfires, and for understanding environmental health disparities (i.e., environmental justice). Our results will have implications for management of health during co-occurring heat and air pollution events, including wildfires, and increase knowledge on weather and air pollution preparedness, response, and recovery.

世界卫生组织将空气污染和气候变化列为2019年和早期研究的十大威胁之一