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Stroke is a leading cause of morbidity and mortality in the United States with 795,000 people experiencing a new or recurrent stroke every year. Identifying modifiable risk factors for stroke should therefore be considered a research priority. While associations between ambient exposure to air pollution and other cardiovascular diseases are well established in the literature, the evidence linking particulate matter (PM) air pollution exposures to the risk of ischemic or hemorrhagic stroke remains equivocal. Furthermore, the exact pathophysiologic mechanisms by which exposure to PM may lead to cerebrovascular events are not yet fully understood. Hypothesized pathways include the mediation of effects through a combination of inflammatory responses, autonomic dysregulation, and/or vascular endothelial disturbances. This dissertation addresses existing gaps in the literature in three separate studies. Two time-stratified case-crossover studies examined the association between short-term PM exposures and stroke risk, one in the Health Professionals Follow-up Study (HPFS) and the other among a large database of Maryland stroke hospitalizations. Conditional logistic regression models were used to examine associations by stroke subtype, population subgroups, and clinically-relevant variables. Our third study took place within the Nurses’ Health Study cohort. Multivariable linear regression models were used to examine the associations between PM and residential distance to road exposures and four inflammatory biomarkers (CRP, IL-6, fibrinogen, and ICAM-1). We found positive significant associations between PM10 and ischemic stroke events in the HPFS cohort, and associations were elevated for nonsmokers, aspirin nonusers, and those without a history of high cholesterol. Concentrations were elevated for both CRP and IL-6 among participants who lived close to a major roadway, but no significant results were found by estimated PM exposure. This work provides additional evidence

Several studies have investigated the association between asthma exacerbations and exposures to ambient temperature and precipitation. However, limited data exists regarding how extreme events, projected to grow in frequency, intensity, and duration in the future in response to our changing climate, will impact the risk of hospitalization for asthma. The objective of our study was to quantify the association between frequency of extreme heat and precipitation events and increased risk of hospitalization for asthma in Maryland between 2000 and 2012. We used a time-stratified case-crossover design to examine the association between exposure to extreme heat and precipitation events and risk of hospitalization for asthma (ICD-9 code 493, n = 115,923). Occurrence of extreme heat events in Maryland increased the risk of same day hospitalization for asthma (lag 0) by 3 % (Odds Ratio (OR): 1.03, 95 % Confidence Interval (CI): 1.00, 1.07), with a considerably higher risk observed for extreme heat events that occur during summer months (OR: 1.23, 95 % CI: 1.15, 1.33). Likewise, summertime extreme precipitation events increased the risk of hospitalization for asthma by 11 % in Maryland (OR: 1.11, 95 % CI: 1.06, 1.17). Across age groups, increase in risk for asthma hospitalization from exposure to extreme heat event during the summer months was most pronounced among youth and adults, while those related to extreme precipitation event was highest among ≤4 year olds. Exposure to extreme heat and extreme precipitation events, particularly during summertime, is associated with increased risk of hospitalization for asthma in Maryland. Our results suggest that projected increases in frequency of extreme heat and precipitation event will have significant impact on public health.

Several studies have investigated the association between asthma exacerbations and exposures to ambient temperature and precipitation. However, limited data exists regarding how extreme events, projected to grow in frequency, intensity, and duration in the future in response to our changing climate, will impact the risk of hospitalization for asthma. The objective of our study was to quantify the association between frequency of extreme heat and precipitation events and increased risk of hospitalization for asthma in Maryland between 2000 and 2012. We used a time-stratified case-crossover design to examine the association between exposure to extreme heat and precipitation events and risk of hospitalization for asthma (ICD-9 code 493, n = 115,923). Occurrence of extreme heat events in Maryland increased the risk of same day hospitalization for asthma (lag 0) by 3 % (Odds Ratio (OR): 1.03, 95 % Confidence Interval (CI): 1.00, 1.07), with a considerably higher risk observed for extreme heat events that occur during summer months (OR: 1.23, 95 % CI: 1.15, 1.33). Likewise, summertime extreme precipitation events increased the risk of hospitalization for asthma by 11 % in Maryland (OR: 1.11, 95 % CI: 1.06, 1.17). Across age groups, increase in risk for asthma hospitalization from exposure to extreme heat event during the summer months was most pronounced among youth and adults, while those related to extreme precipitation event was highest among ≤4 year olds. Exposure to extreme heat and extreme precipitation events, particularly during summertime, is associated with increased risk of hospitalization for asthma in Maryland. Our results suggest that projected increases in frequency of extreme heat and precipitation event will have significant impact on public health.