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PURE-Climate: Identifying and Adapting to Climate Change as a Modifiable Risk Factor for Human Health

Funding:  National Institute for Environmental Health Sciences (NIEHS), 1R56ES035095-01A1 (PI: Hystad)

This research will conduct geospatial and epidemiological analyses within the ongoing Prospective Urban and Rural Epidemiology (PURE) study. PURE is a prospective cohort (median follow-up: 12 years) of 200,000 adults across 998 urban/rural communities in 27 low-, middle-, and high- income countries (see map for community locations below).  We will assess climate-driven exposures for PURE communities (e.g. extreme heat, flooding) using state-of-the-art geospatial assessment methods and determine the direct and indirect impacts of climate-driven exposures on diverse health outcomes and determine vulnerability and resilience factors.

The PURE-Climate grant will provide new information on how climate change influences human health, especially in LMICs, and demonstrate how these impacts can be reduced through adaptation and local climate resilience. This information is central to evidence-based climate-health policies.

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PURE-Air: A Global Assessment of Outdoor Air Pollution and Cardiopulmonary Disease

Funding NIH Director’s Early Independence Awards. DP5ODO19850 (PI: Hystad)

Air pollution is linked to increased risks of mortality and cardiovascular and respiratory diseases; however, most studies of long-term air pollution exposure have been conducted in high-income countries with relatively low air pollution concentrations. In this project, we conducted the first global health study of air pollution using the large multi-national PURE cohort study, including individuals living in low and middle income countries with high air pollution levels.

We conducted an exposure assessment that integrated survey data, GIS and satellite models, and new air pollution monitoring. We collected air pollution measurements in 4,500 households and for 1,200 individuals living in 120 communities in eight countries to characterize air pollution exposure levels and drivers. Using clean fuels for cooking and heating substantially lowers kitchen PM2.5 concentrations. Importantly, average kitchen and personal PM2.5 measurements for all primary fuel types exceeded WHO's Interim Target-1 (35 μg/m3 annual average), highlighting the need for comprehensive air pollution mitigation strategies. The PURE-AIR monitoring database is orders of magnitude larger than previous monitoring studies and provides important new information on air pollution exposures and drivers in developing countries.

We observed associations between cooking with solid fuels, compared to clean fuels, and mortality as well as cardiovascular and respiratory disease. Overall, 6.6% of deaths and 6.9% of new cardiovascular cases could be attributed to household air pollution. 4.) We observed associations between outdoor fine particulate matter (PM2.5) air pollution and cardiovascular disease. We estimated that 13.9% of new cardiovascular cases could be attributed to ambient PM2.5 air pollution. Our study findings suggest that PM2.5 air pollution is an important global risk factor for cardiovascular disease.

We have ongoing research in the PURE study that is examining different air pollution exposures, and change in exposures over time, and diverse clinical measures (e.g. blood pressure, lung function) biomarkers, and health outcomes.