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

> **NIH NIH RF1** · YALE UNIVERSITY · 2023 · $2,378,546

## Abstract

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 disp...

## Key facts

- **NIH application ID:** 10607424
- **Project number:** 1RF1AG080948-01
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Michelle L Bell
- **Activity code:** RF1 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $2,378,546
- **Award type:** 1
- **Project period:** 2022-12-15 → 2025-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10607424

## Citation

> US National Institutes of Health, RePORTER application 10607424, Susceptibility and adverse health outcomes related to climate-sensitive events among older Medicare beneficiaries with Alzheimer and Dementia (1RF1AG080948-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10607424. Licensed CC0.

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