ENVISION Research Group
Single- and Multi-Location Air Quality & Acute Morbidity

Single- and Multi-Location Air Quality & Acute Morbidity

Numerous time-series studies have shown associations between environmental exposures such as ambient air pollution and increased risk of mortality, hospital admissions, and emergency department (ED) visits. However, several major questions remain about the degree to which these findings are generalizable between locations, source mixtures, and populations. In addition, work remains in understanding whether observed health effects are due to individual pollutants or to pollutants acting in combination with other pollutants. Bioaerosols (pollen and mold) and weather events such as extreme heat and precipitation have been associated with increased morbidity and mortality and add to the health burden of air quality. A better understanding of air quality-related morbidity at the local and national levels is important for developing the infrastructure, policy, and public health messages to help vulnerable populations avoid unhealthy exposures.

The purpose of this overarching study for the ENVISION Research Group is to clarify the impacts of environmental exposures on acute severe morbidity in urban and rural regions across the U.S. using a novel multi-state database of emergency department visits and hospitalizations and a variety of environmental exposure metrics. This study also serves as an umbrella for several focused projects listed on the Projects tab.

Study Locations: Georgia, Arizona, California, Maryland, Missouri, Nevada, New Jersey, New York, North Carolina, Oregon, and Utah

Investigators: Stefanie Ebelt, Howard Chang, Noah Scovronick

Current or Recent Funding Sources: National Institutes of Health (R01ES027892)

Previous Funding Sources: National Institutes of Health (R21ES022795, R21ES023763), Electric Power Research Institute (EP-P25912/C12525, EP-P34975/C15892 and EP-P45572/C19698, 10002467, 10009553), US Environmental Protection Agency (CR-83407301, RD-83479901), Health Effects Institute (4912-RFA11-1/12-6)

Category: Air Pollution

PUBLICATIONS (* = student author)

Multi-Location Publications

  1. Landry M*, D’Souza R, Moss S, Chang HH, Ebelt S, Wilson L, Scovronick N. The association between ambient temperature and snakebite in Georgia, USA: a case-crossover study. PLOS Neglected Tropical Diseases, accepted. (link)
  2. Bi J, D’Souza RR, Moss S, Scovronick N, Chang HH, Ebelt S. Acute effects of ambient air pollution on asthma emergency department visits in 10 U.S. states. Environmental Health Perspectives 131(4):047003, 2023. (link)
  3. Zhang H, Shi L, Ebelt ST, D’Souza RR, Schwartz JD, Scovronick N, Chang HH. Short-term associations between ambient air pollution and emergency department visits for Alzheimer’s disease and related dementias. Environmental Epidemiology 7(1):e237, 2023. (link)
  4. Zhang Y, Ebelt ST, Shi L, Scovronick N, D’Souza RR, Steenland K, Chang HH. Short-term associations between warm-season ambient temperature and emergency department visits for Alzheimer’s disease and related dementia in five US states. Environmental Research 220:115176, 2023. (link)
  5. Richards M, Huang M, Strickland M, Newman A, Warren J, D’Souza R, Chang H, Darrow L. Acute association between heatwaves and stillbirth in six US states. Environmental Health 21(1):59-59, 2022. (link)
  6. Thomas N*, Ebelt ST, Newman AJ, Scovronick N, D’Souza RR, Moss S, Warren JL, Strickland MJ, Darrow LA, Chang HH. Time-series analysis of daily ambient temperature and emergency department visits in five US cities with a comparison of exposure metrics derived from 1-km meteorology products. Environmental Health 20:55, 2021. (link)

Foundational Multi-Location Work

  1. Barry V, Klein M, Winquist A, Chang HH, Mulholland JA, Talbott E, Rager J, Tolbert P, Sarnat SE. Characterization of the concentration-response curve for ambient ozone and acute respiratory morbidity in 5 U.S. cities. Journal of Exposure Science and Environmental Epidemiology, 29:267-277, 2019. (link)
  2. Krall JR, Chang HH, Waller LA, Mulholland JA, Winquist A, Talbott EO, Rager JJ, Tolbert PE, Sarnat SE. A multicity study of air pollution and cardiorespiratory emergency department visits: comparing approaches for combining estimates across cities. Environment International, 20:312-320, 2018. (link)
  3. Friberg MD*, Kahn RA, Holmes HA, Chang HH, Sarnat SE, Tolbert PE, Russell AG, Mulholland JA. Daily ambient air pollution metrics for five cities: evaluation of data-fusion-based estimates and uncertainties. Atmospheric Environment, 158(6):36-50, 2017. (link)
  4. O’Lenick CR*, Chang HH, Kramer MR, Winquist A, Mulholland JA, Friberg MD, Sarnat SE. Ozone and childhood respiratory disease in three US cities: evaluation of effect measure modification by neighborhood socioeconomic status using a Bayesian hierarchical approach. Environmental Health, 16:36, 2017. (link)
  5. Krall JR, Mulholland JA, Russell AG, Balachandran S, Winquist A, Tolbert PE, Waller LA, Sarnat SE. Associations between source-specific fine particulate matter and emergency department visits for respiratory disease in four U.S. cities. Environmental Health Perspectives, 125:97-103, 2017. (link)
  6. Alhanti BA*, Chang HH, Winquist A, Mulholland JA, Darrow L, Sarnat SE. Ambient air pollution and emergency department visits for asthma: a multi-city assessment of effect modification by age. Journal of Exposure Science and Environmental Epidemiology, 26:180-188, 2016. (link)
  7. Gass K*, Klein M, Sarnat SE, Winquist A, Darrow LA, Flanders WD, Chang HH, Mulholland JA, Tolbert PE, Strickland MJ. Associations between ambient air pollutant mixtures and pediatric asthma emergency department visits in three cities: a classification and regression tree approach. Environmental Health, 14:58, 2015. (link)

Single-Location Publications

  1. Lappe BL*, Ebelt S, D’Souza RR, Manangan A, Brown C, Saha S, Harris D, Chang HH, Sole A, Scovronick N. Pollen and emergency department visits for asthma and wheeze in Atlanta, GA: a 26-year time-series study. Environment International, in press. (link)
  2. Ebelt ST, D’Souza RR, Yu H, Scovronick N, Moss S, Chang HH. Monitoring vs. modeled exposure data in time-series studies of ambient air pollution and acute health outcomes. Journal of Exposure Science and Environmental Epidemiology 33:377-385, 2023. (link)
  3. Dharmalingam S, Senthilkumar N, D’Souza RR, Hu Y, Chang HH, Ebelt S, Yu H, Kim CS, Rohr A. Developing air pollution concentration fields for health studies using multiple methods: cross-comparison and evaluation. Environmental Research 207:112207, 2022. (link)
  4. Miller AG*, Ebelt S, Levy K. Combined sewer overflows and gastrointestinal illness in Atlanta, 2002 to 2013: evaluating the impact of infrastructure improvements. Environmental Health Perspectives 130(5):057009, 2022. (link)
  5. Bi J*, Barry V, Weil EJ, Chang HH, Ebelt S. Short-term exposure to fine particulate air pollution and emergency department visits for kidney diseases in the Atlanta metropolitan area. Environmental Epidemiology 5:e164, 2021. (link)
  6. Jiang S*, Warren JL, Scovronick N, Moss S, Darrow LA, Strickland MJ, Newman AJ, Chen Y, Ebelt S, Chang HH. Using logic regression to characterize extreme heat exposures and their health associations: a time-series study of emergency department visits in Atlanta. BMC Medical Research Methodology 21:87, 2021. (link)
  7. Bi J*, D’Souza R, Rich DQ, Hopke P, Russell AG, Liu Y, Chang HH, Ebelt S. Temporal changes in short-term associations between cardiorespiratory emergency department visits and PM2.5 in Los Angeles, 2005 to 2016. Environmental Research 190:109967, 2020. (link)

Foundational Single-Location Work

  1. Blumberg AH*, Ebelt ST, Liang D, Morris CR, Sarnat JA. Ambient air pollution and sickle cell disease exacerbations in Atlanta, GA. Environmental Research 184:109292, 2020. (link)
  2. Pennington AF*, Strickland MJ, Gass K*, Klein M, Sarnat SE, Tolbert PE, Balachandran S, Chang HH, Russell AG, Mulholland JA, Darrow LA. Source-apportioned PM2.5 and cardiorespiratory emergency department visits: accounting for source contribution uncertainty. Epidemiology, 30:789-798, 2019. (link)
  3. Pan A*, Sarnat SE, Chang HH. Time-series analysis of air pollution and health accounting for covariate-dependent overdispersion. American Journal of Epidemiology, 187(12):2698-2704, 2018. (link)
  4. Ye D*, Klein M, Mulholland JA, Russell AG, Weber R, Edgerton ES, Chang HH, Sarnat JA, Tolbert PE, Sarnat SE. Estimating acute cardiovascular effects of ambient PM2.5 metals. Environmental Health Perspectives, 126(2): 027007, 2018. (link)
  5. Abrams JY*, Weber RJ, Klein M, Sarnat SE, Chang HH, Strickland MJ, Verma V, Fang T, Bates JT, Mulholland JA, Russell AG, Tolbert PE. Associations between ambient fine particulate oxidative potential and cardiorespiratory emergency department visits. Environmental Health Perspectives, 125(10):107008, 2017. (link)
  6. Chen T*, Sarnat SE, Grundstein AJ, Winquist A, Chang HH. Time-series analysis of heat waves and emergency department visits in Atlanta, 1993 to 2012. Environmental Health Perspectives, 125(5):057009, 2017. (link)
  7. O’Lenick CR*, Winquist A, Chang HH, Kramer MR, Mulholland JA, Grundstein A, Sarnat SE. Evaluation of individual and area-level factors as modifiers of the association between warm-season temperature and pediatric asthma morbidity in Atlanta, GA. Environmental Research, 156:132-144, 2017b. (link)
  8. Ye D*, Klein M, Chang HH, Sarnat JA, Mulholland JA, Edgerton ES, Winquist A, Tolbert PE, Sarnat SE. Estimating acute cardiorespiratory effects of ambient volatile organic compounds. Epidemiology, 28:197-206, 2017. (link)
  9. O’Lenick CR*, Winquist A, Mulholland JA, Friberg MD, Chang HH, Kramer MR, Darrow LA, Sarnat SE. Assessment of neighbourhood-level socioeconomic status as a modifier of air pollution-asthma associations among children in Atlanta. Journal of Epidemiology and Community Health, 71:129-136, 2017. (link)
  10. Heidari L*, Winquist A, Klein M, O’Lenick CR, Grundstein A, Sarnat SE. Susceptibility to heat-related fluid and electrolyte imbalance emergency department visits in Atlanta, Georgia, USA. International Journal of Environmental Research and Public Health – Special Issue on Climate Change and Human Health, 13:982, 2016. (link)
  11. Pearce JL, Waller LA, Sarnat SE, Chang HH, Klein M, Mulholland JA, Tolbert PE. Characterizing the spatial distribution of multiple pollutants and populations at risk in Atlanta, Georgia. Spatial and Spatio-Temporal Epidemiology, 18:13-23, 2016. (link)
  12. Winquist A, Grundstein A, Chang HH, Hess J, Sarnat SE. Warm-season temperatures and emergency department visits in Atlanta, Georgia. Environmental Research, 147:314-323, 2016. (link)
  13. Fang T, Verma V, Bates JT, Abrams J, Klein M, Strickland MJ, Sarnat SE, Chang HH, Mulholland JA, Tolbert PE, Russell AG, Weber RJ. Oxidative potential of ambient water-soluble PM2.5 in the southeastern United States: contrasts in sources and health associations between ascorbic acid (AA) and dithiothreitol (DTT) assays. Atmospheric Chemistry and Physics, 16:3865-3879, 2016. (link)
  14. Bates JT*, Weber RJ, Abrams J, Verma V, Fang T, Klein M, Strickland MJ, Sarnat SE, Chang HH, Mulholland JA, Tolbert PE, Russell AG. Reactive oxygen species generation linked to sources of atmospheric particulate matter and cardiorespiratory effects. Environmental Science & Technology, 49(22):13605-12, 2015. (link)
  15. Pearce JL, Waller LA, Mulholland JA, Sarnat SE, Strickland MJ, Chang HH, Tolbert PE. Exploring associations between multipollutant day types and asthma morbidity: epidemiologic applications of self-organizing map ambient air quality classifications. Environmental Health, 14:55, 2015. (link)
  16. Sarnat SE, Winquist A, Schauer JJ, Turner J, Sarnat JA. Fine particulate matter components and emergency department visits for cardiovascular and respiratory diseases in St. Louis, Missouri-Illinois, metropolitan area. Environmental Health Perspectives, 123:437-444, 2015. (link)
  17. Winquist A, Schauer JJ, Turner J, Klein M, Sarnat SE. Impact of ambient fine particulate matter carbon measurement methods on observed associations with acute cardiorespiratory morbidity. Journal of Exposure Science and Environmental Epidemiology, 25:215-221, 2015. (link)
  18. Winquist A, Kirrane E, Klein M, Strickland M, Darrow L, Sarnat SE, Gass K, Mulholland J, Russell A, Tolbert P. Joint effects of combinations of ambient air pollutants on pediatric emergency department visits in Atlanta, 1998-2004. Epidemiology, 25:666-673, 2014. (link)
  19. Pearce JL, Waller LA, Chang HH, Klein M, Mulholland JA, Sarnat JA, Sarnat SE, Strickland MJ, Tolbert PE. Using self-organizing maps to develop ambient air quality classifications: a time series example. Environmental Health, 13:56, 2014. (link)
  20. Chang HH, Hao H*, Sarnat SE. A statistical modeling framework for projecting future ambient ozone and its health impact due to climate change. Atmospheric Environment 89:290-297, 2014. (link)
  21. Sarnat JA, Sarnat SE, Flanders WD, Chang HH, Mulholland J, Baxter L, Isakov V, Özkaynak H. Spatiotemporally-resolved air exchange rate as a modifier of acute air pollution-related morbidity in Atlanta. Journal of Exposure Science and Environmental Epidemiology 23:606-615, 2013. (link)
  22. Sarnat SE, Sarnat JA, Mulholland J, Isakov V, Özkaynak H, Chang HH, Klein M, Tolbert PE. Application of alternative spatiotemporal metrics of ambient air pollution exposure in a time-series epidemiological study in Atlanta. Journal of Exposure Science and Environmental Epidemiology 23:593-605, 2013. (link)
  23. Winquist A, Klein M, Tolbert P, Flanders WD, Hess J, Sarnat SE. Comparison of emergency department and hospital admissions data for air pollution time-series studies. Environmental Health, 11:70, 2012. (link)
  24. Winquist A, Klein M, Tolbert P, Sarnat SE. Power estimation using simulations in air pollution time-series studies. Environmental Health 11:68, 2012. (link)
  25. Darrow LA, Hess J, Rogers CA, Tolbert PE, Klein M, Sarnat SE. Ambient pollen concentrations and emergency department visits for asthma and wheeze. Journal of Allergy and Clinical Immunology 130:630-638, 2012. (link)
  26. Flanders WD, Klein M, Darrow LA, Strickland MJ, Sarnat SE, Sarnat JA, Waller LA, Winquist A, Tolbert PE. A method to detect residual confounding in spatial and other observational studies.  Epidemiology 22:823-826, 2011. (link)
  27. Flanders WD, Tolbert PE, Darrow L, Strickland M, Sarnat S, Sarnat J, Waller L, Winquist A, Klein M. A method for detection of residual confounding in time-series and other observational studies. Epidemiology 22:59-67, 2011. (link)
  28. Darrow L, Klein M, Sarnat JA, Mulholland JA, Strickland MJ, Sarnat SE, Russell AG, Tolbert PE. The use of alternative pollutant metrics in time-series studies of ambient air pollution and respiratory emergency department visits. Journal of Exposure Science and Environmental Epidemiology 21:10-19, 2011. (link)
  29. Strickland MJ, Darrow LA, Klein M, Flanders WD, Sarnat JA, Waller LA, Sarnat SE, Mulholland JA, Tolbert PE. Short-term associations between ambient air pollutants and pediatric asthma emergency department visits. American Journal of Respiratory & Critical Care Medicine 182:307-316, 2010. (link)
  30. Sarnat SE, Klein M, Sarnat JA, Mulholland J, Russell AG, Flanders WD, Waller LA, Tolbert PE.  An examination of exposure measurement error from air pollutant spatial variability in time-series studies. Journal of Exposure Science and Environmental Epidemiology 20:135-146, 2010. (link)
  31. Grundstein A, Sarnat SE, Klein M, Shepherd M, Naeher L, Mote T, Tolbert P. Thunderstorm-associated asthma in Atlanta, Georgia. Thorax 63:659-660, 2008. (link)
  32. Sarnat JA, Marmur A, Klein M, Kim E, Russell AG, Sarnat SE, Mulholland JA, Hopke PK, Tolbert PE. Fine particle sources and cardiorespiratory morbidity: an application of chemical mass balance and factor analytical source apportionment methods. Environmental Health Perspectives 116:459-466, 2008. (link)
  33. Tolbert PE, Klein M, Peel JL, Sarnat SE, Sarnat JA. Multipollutant modeling issues in a study of ambient air quality and emergency department visits in Atlanta. Journal of Exposure Science and Environmental Epidemiology 17:S29-S35, 2007. (link)