# REACH Center Research Project 2

> **NIH NIH P20** · GEORGE WASHINGTON UNIVERSITY · 2024 · $190,034

## Abstract

SUMMARY - RESEARCH PROJECT 2: Landscape fire PM2.5, air conditioning, and mortality among
dialysis patients
Patients with end-stage renal disease (ESRD) would benefit from more knowledge about health risks posed by
climate change. One risk that is not fully explored for these patients is the long-term impact of exposure to fine
particulate matter (PM2.5) from landscape fire smoke. Large wildfires, an important portion of landscape fires,
have increased in frequency and size and models project that the risk of these fires will increase in coming
years due to climate change. Though research has shown that short-term exposure to landscape fire PM2.5
(e.g., 1-30 days) increases risk of all-cause mortality among patients receiving dialysis, we do not yet know if
long-term exposure to landscape fire PM2.5 increases mortality among ESRD dialysis patients. In addition,
residential factors that may mitigate climate change-related risks have not been fully explored for ESRD
patients. One of these residential factors is residential air conditioning (AC), which may provide multiple
benefits, including potentially reducing exposure to both heat and PM2.5 (from all outdoor sources). Recent
research has shown unequal intra-urban distribution of residential AC prevalence across metropolitan areas in
the US. We will examine whether residential AC prevalence may influence mortality among dialysis patients. In
coordination with the Community Engagement Core (CEC), we will work with a patient advisory board from the
American Association of Kidney Patients (AAKP) to discuss planned and future research, disseminate results,
and plan for continued engagement. The US Renal Data System (USRDS) maintains a nationwide registry of
patients who require dialysis. We will use the USRDS data of approximately 1.5 million patients who initiated
dialysis between 2006-2018 and follow them until 2019, creating a retrospective cohort to examine whether
landscape fire PM2.5 or AC prevalence influence mortality in dialysis patients. For Aim 1, our exposure is
number of days exposed to elevated landscape fire PM2.5, defined as days when landscape fire PM2.5
exceeded the current National Ambient Air Quality Standards 24-hr standard for PM2.5 of 35 µg/m3. We will use
publicly available estimates of 24-hr mean landscape fire PM2.5 (and control for non-fire PM2.5), which uses
spatially interpolated PM2.5 observations, available on a 15 x 15 km grid, for the full contiguous US each day.
We will interpolate the data to the ZIP code level, as residential ZIP codes are available for dialysis patients.
We will use a semiparametric multi-level mixed-effect Cox hazards regression for mortality and estimate the
hazard ratios of our exposure (landscape fire PM2.5 or prevalence of AC), adjusting for both individual- and
community-level covariates. For Aim 2, AC prevalence was previously estimated for 115 metropolitan areas.
We will restrict our analyses to examine these 115 metropolitan areas and emp...

## Key facts

- **NIH application ID:** 10982794
- **Project number:** 1P20ES036775-01
- **Recipient organization:** GEORGE WASHINGTON UNIVERSITY
- **Principal Investigator:** Katie M. Applebaum
- **Activity code:** P20 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $190,034
- **Award type:** 1
- **Project period:** 2024-09-19 → 2027-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10982794

## Citation

> US National Institutes of Health, RePORTER application 10982794, REACH Center Research Project 2 (1P20ES036775-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10982794. Licensed CC0.

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