High ambient temperature is a well-recognized environmental hazard to human health. The overarching goal of this project is to examine factors related to physiologic susceptibility and factors along exposure pathways that may lead to disparities in heat-related illnesses. The project also aims to map features within multiple social determinants of health (SODH) domains that can alter an individual’s ability to mitigate heat exposure to help identify actionable intervention strategies.
Aim 1 will quantify disparities in associations between heat and emergency department (ED) visits in Atlanta, GA during the period 2013 to 2021. We will assess patient level effect modifiers (e.g., age, sex, homelessness, insurance status, co-morbid conditions, and home medication), and modifiers that are related to the residential built environment (e.g., building type, building year and green space).
Aim 2 will conduct a matched case-control study to examine risk factors for heat-related ED visits that are not captured through medical records, such as how and why exposure occurred. To address knowledge gaps in the understanding of heat exposures, Aim 3 will characterize temperature exposure for individuals living in under-resourced communities by conducting 48-hour continuous monitoring of personal, indoor and outdoor exposure to temperature, humidity and air quality. We will characterize absolute differences between personal, indoor, and outdoor temperatures, as well as identify demographic, behavioral, socioeconomic, time-activity-location, and built environment factors contributing to these differences in exposures.
In all Aims, we will engage with community partners to determine additional salient risk factors, develop surveys and interviews, and identify participants for recruitment. Overall, the project will provide timely knowledge on the adverse health effects of heat in an urban setting with a focus on under-resourced communities.
Study Locations: Georgia
Investigators: Howard Chang, Stefanie Ebelt, Eri Saikawa, Christine Ekenga, Noah Scovronick
Current or Recent Funding Sources: National Institutes of Health (1P20ES036110-01)
Category: Temperature
Link to full project: https://climate.sph.emory.edu/chart/
PUBLICATIONS (* = student author)
Project Publications
- Rabin B, D’Souza R, Weil EJ, Chang HH, Ebelt S, Scovronick N. Estimating the Association Between Outdoor Temperature and Acute Kidney Injury Using Alternative Case Definitions. Journal of Occupational and Environmental Medicine. 2025 May 1;67(5):e287-e293. (link)
- McCann ZH, Zhang H, Mueller K, D’Souza RR, Qian Y, Lane M, Weil EJ, Ebelt S, Scovronick N, Chang HH. A case-crossover assessment of the modifying effects of home medication use on acute kidney-related morbidity due to elevated ambient heat exposure in Atlanta, GA from 2013 to 2019. BMJ Public Health 3:e001703, 2025. (link)
- Englert JR, Ebelt S, Chang H. Modeling joint health effects of environmental exposure mixtures with Bayesian additive regression trees. Statistics in Medicine 44:e70250, 2025. (link)
- Englert JR, Ebelt ST, Chang H. Estimating heterogeneous exposure effects in the case-crossover design using BART. Journal of the American Statistical Association 00:1-12, 2025. (link)