Stefanie Ebelt

• ScD
• Professor (Associate) at Emory University

Introduction: Fine particulate matter (PM2.5) is a known risk factor for Alzheimer's disease (AD), with emerging evidence linking PM2.5 exposure to cerebrospinal fluid (CSF) biomarkers in pre-clinical stages. However, the role of DNA methylation (DNAm) as potential mediator in this relationship among cognitively normal individuals remains largely u...

High ambient temperature poses significant health risk globally. However, the relative importance of different exposure pathways leading to health risks remains unclear. For 9 US states during 2016–2018, ED visit records for heat exhaustion and heat stroke (HEAT), fluid and electrolyte imbalance (FEI), volume depletion (VD), and acute kidney injury...

Emergency department (ED) visits during influenza seasons represent a critical yet less examined indicator of the acute burden of influenza. This study investigates the burden of influenza-associated ED visits in six U.S. cities during influenza seasons from 2005-06 to 2016-17. Using a time-series design, we estimated associations between daily ED...

Objective: To improve estimates of the association between acute kidney injury (AKI) and ambient heat exposure through better case ascertainment and by isolating community-acquired AKI. Methods: We conducted a case-crossover study using data on AKI-related emergency department (ED) visits in Atlanta. Daymet meteorology was used to assess exposure....

Cognitive impairment and dementia have long been recognized as growing public health threats. Studies have found that air pollution is a potential risk factor for dementia, but the literature remains inconclusive. This study aimed to evaluate the association between three major air pollutants (i.e., PM2.5, O3, and NO2) and cognitive impairment amon...

Studying the association between mixtures of environmental exposures and health outcomes can be challenging due to issues such as correlation among the exposures and non-linearities or interactions in the exposure-response function. For this reason, one common strategy is to fit flexible nonparametric models to capture the true exposure-response su...

Climate change is projected to increase the risk of dust storms, particularly in subtropical dryland, including the southwestern US. Research on dust storm’s health impacts in the US is limited and hindered by challenges in dust storm identification. This study assesses the potential link between dust storms and cardiorespiratory emergency departme...

Background: Epidemiological evidence suggests air pollution adversely affects cognition and increases the risk of Alzheimer's disease (AD), but little is known about the biological effects of fine particulate matter (PM2.5, particulate matter with aerodynamic diameter ≤2.5μm) on early predictors of future disease risk. Objectives: We investigate...

Background Pollen exposure is associated with substantial respiratory morbidity, but its potential impact on cardiovascular disease (CVD) remains less understood. This study aimed to investigate the associations between daily levels of 13 pollen types and emergency department (ED) visits for eight CVD outcomes over a 26-year period in Atlanta, GA....

Background and Objectives Fine particulate matter (PM 2.5 ) exposure has been found to be associated with Alzheimer disease (AD) and is hypothesized to cause inflammation and oxidative stress in the brain, contributing to neuropathology. The APOE gene, a major genetic risk factor of AD, has been hypothesized to modify the association between PM 2.5...

INTRODUCTION Growing evidence indicates that fine particulate matter (PM2.5) is a risk factor for Alzheimer's disease (AD), but the underlying mechanisms have been insufficiently investigated. We hypothesized differential DNA methylation (DNAm) in brain tissue as a potential mediator of this association. METHODS We assessed genome‐wide DNAm (Illum...

Introduction Ambient particulate matter ≤ 2.5 µm in aerodynamic diameter (PM 2.5 ) exposure elevates the risk for cardiovascular disease morbidity (CVDM). The aim of this study is to characterise which area-level measures of socioeconomic position (SEP) modify the relationship between PM 2.5 exposure and CVDM in Missouri at the census-tract (CT) le...

Background Short-term temperature variability, defined as the temperature range occurring within a short time span at a given location, appears to be increasing with climate change. Such variation in temperature may influence acute health outcomes, especially cardiovascular diseases (CVD). Most research on temperature variability has focused on the...

Background Here, we investigate the association between outdoor temperature and fatal police shootings in the United States between 2015 and 2021. Methods We conducted a time-stratified case-crossover study. Data on fatal police shootings were from the Washington Post’s Fatal Force database and temperature data were from Daymet. Results A 5°C inc...

Ambient PM2.5 exposure elevates the risk for cardiovascular disease morbidity (CVDM). The aim of this study is to characterize which area-level measures of socioeconomic position (SEP) modify the relationship between PM2.5 exposure and CVDM in Missouri at the census-tract (CT) level. We use individual level Missouri emergency department (ED) admiss...

Dust storms are increasing in frequency and correlate with adverse health outcomes but remain understudied in the United States (U.S.), partially due to the limited spatio‐temporal coverage, resolution, and accuracy of current data sets. In this work, dust‐related metrics from four public areal data products were compared to a monitor‐based “gold s...

The World Health Organization has identified snakebite envenoming as a highest priority neglected tropical disease, yet there is a dearth of epidemiologic research on environmental risk factors, including outdoor temperature. Temperature may affect snakebites through human behavior or snake behavior; snakes are ectotherms, meaning outdoor temperatu...

INTRODUCTION: Growing evidence indicates fine particulate matter (PM2.5) as risk factor for Alzheimer's disease (AD), but the underlying mechanisms have been insufficiently investigated. We hypothesized differential DNA methylation (DNAm) in brain tissue as potential mediator of this association. METHODS: We assessed genome-wide DNAm (Illumina EPIC...

Background: Epidemiological evidence suggests air pollution adversely affects cognition and increases the risk of Alzheimer′s disease (AD), but little is known about the biological effects of fine particulate matter (PM2.5) on early predictors of future disease risk. Objectives: We investigated the association between 1, 3, and 5-year exposure to a...

Background Short-term temperature variability, defined as the temperature range occurring within a short time span at a given location, appears to be increasing with climate change. Such variation in temperature may influence acute health outcomes, especially cardiovascular diseases (CVD). Most research on temperature variability has focused on the...

Background: Compared to many environmental risk factors, the relationship between pollen and asthma is understudied, including how associations may differ by pollen type and between subgroups, and how associations may be changing over time. Objectives: We evaluated the association between ambient pollen concentrations and emergency department (E...

Introduction: Pathophysiologic pathways of sickle cell disease (SCD) and air pollution involve inflammation, oxidative stress, and endothelial damage. It is therefore plausible that children with SCD are especially prone to air pollution's harmful effects. Methods: Patient data were collected from a single-center, urban/peri-urban cohort of chil...

Introduction: Higher fine particulate matter (PM2.5) exposure has been found to be associated with Alzheimer's disease (AD). PM2.5 has been hypothesized to cause inflammation and oxidative stress in the brain, contributing to neuropathology. A major genetic risk factor of AD, the apolipoprotein E (APOE) gene, has also been hypothesized to modify th...

Background: Previous studies of short-term ambient air pollution exposure and asthma morbidity in the United States have been limited to a small number of cities and/or pollutants and with limited consideration of effects across ages. Objectives: To estimate acute age group-specific effects of fine and coarse particulate matter (PM), major PM co...

Background: Studies of thunderstorm asthma to understand risk factors using high-resolution climate data and asthma outcomes on a large scale are scarce. Moreover, thunderstorm asthma is not well studied in the United States. Objectives: We examined whether climate parameters involved in thunderstorms are associated with emergency department (ED...

Background Air pollution and neighborhood socioeconomic status (nSES) have been shown to affect cognitive decline in older adults. In previous studies, nSES acts as both a confounder and an effect modifier between air pollution and cognitive decline. Objectives This study aims to examine the individual and joint effects of air pollution and nSES o...

Background: Combined sewer overflows (CSOs) discharge untreated sewage into surface and recreational water, often following heavy precipitation. Given projected increases in frequency and intensity of precipitation due to climate change, it is important to understand the health impacts of CSOs and mediating effects of sewerage systems. Objectives...

Background Air pollution has been associated with cognitive function in the elderly. Previous studies have not evaluated the simultaneous effect of neighborhood-level socioeconomic status (N-SES), which can be an essential source of bias. Objectives We explored N-SES as a confounder and effect modifier in a cross-sectional study of air pollution a...

Past air pollution epidemiological studies have used a wide range of methods to develop concentration fields for health analyses. The fields developed differ considerably among these methods. The reasons for these differences and comparisons of their strengths, as well as the limitations for estimating exposures, remains under-investigated. Here, w...

Background: Toxicological evidence has shown that fine particulate matter (PM2.5) may affect distant organs, including kidneys, over the short term. However, epidemiological evidence is limited. Objectives: We investigated associations between short-term exposure to PM2.5, major PM2.5 components [elemental carbon (EC), organic carbon (OC), sulfa...

Background Ambient temperature observations from single monitoring stations (usually located at the major international airport serving a city) are routinely used to estimate heat exposures in epidemiologic studies. This method of exposure assessment does not account for potential spatial variability in ambient temperature. In environmental health...

Background Short-term associations between extreme heat events and adverse health outcomes are well-established in epidemiologic studies. However, the use of different exposure definitions across studies has limited our understanding of extreme heat characteristics that are most important for specific health outcomes or subpopulations. Methods Log...

Background Rising temperatures due to climate change are expected to impact human adaptive response, including changes to home cooling and ventilation patterns. These changes may affect air pollution exposures via alteration in residential air exchange rates, affecting indoor infiltration of outdoor particles. We conducted a field study examining a...

Background Substantial research has investigated the adverse effects of traffic-related air pollutants (TRAP) on human health. Convincing associations between TRAP and respiratory and cardiovascular diseases are known, but the underlying biological mechanisms are not well established. High-resolution metabolomics (HRM) is a promising platform for u...

Humans are concurrently exposed to chemically, structurally and toxicologically diverse chemicals. A critical challenge for environmental epidemiology is to quantify the risk of adverse health outcomes resulting from exposures to such chemical mixtures and to identify which mixture constituents may be driving etiologic associations. A variety of st...

Background: The novel human coronavirus disease 2019 (COVID-19) pandemic has claimed more than 600,000 lives worldwide, causing tremendous public health, social, and economic damages. While the risk factors of COVID-19 are still under investigation, environmental factors, such as urban air pollution, may play an important role in increasing populat...

There have been no time-series studies of air pollution in Peru. Here we evaluate the effect of ambient PM2.5 on emergency room (ER) visits in Lima. We estimated daily PM2.5 levels at a 1 km² resolution during 2010–2016 using ground measurements, satellite data, and chemical transport model simulations. Population-weighted average daily PM2.5 level...

Background: Emissions control programs targeting certain air pollution sources may alter PM2.5 composition, as well as the risk of adverse health outcomes associated with PM2.5. Objectives: We examined temporal changes in the risk of emergency department (ED) visits for cardiovascular diseases (CVDs) and asthma associated with short-term increases...

Transition metal ions, such as water-soluble iron (WS-Fe), are toxic components of fine particles (PM2.5). In Atlanta from 1998 to 2013, a previous study found that WS-Fe was the PM2.5 species most associated with adverse cardiovascular outcomes. We examined this data set to investigate the sources of WS-Fe and effects of air quality regulations on...

Background: The novel human coronavirus disease 2019 (COVID-19) pandemic has claimed more than 240,000 lives worldwide, causing tremendous public health, social, and economic damages. While the risk factors of COVID-19 are still under investigation, environmental factors, such as urban air pollution, may play an important role in increasing populat...

Background Information about local air quality is reported across the United States using air quality alerts such as the Environmental Protection Agency's Air Quality Index. However, the role of such alerts in raising awareness of air quality is unknown. We conducted this study to evaluate associations between days with Air Quality Index ≥101, corr...

The full publications from HEI Energy and the Research Committee can be downloaded at https://hei-energy.org/. There are two reports. One is a systematic review of the epidemiology literature and the other is a companion exposure report.

Background: The southeastern United States consistently has high salmonellosis incidence, but disease drivers remain unknown. Salmonella is regularly detected in this region's natural environment, leading to numerous exposure opportunities. Rainfall patterns may impact the survival/transport of environmental Salmonella in ways that can affect dise...

Background: Despite evidence suggesting that air pollution-related health effects differ by emissions source, epidemiologic studies on fine particulate matter (PM2.5) infrequently differentiate between particles from different sources. Those that do rarely account for the uncertainty of source apportionment methods. Methods: For each day in a 12...

Background: Air pollution control policies resulting from the 1990 Clean Air Act Amendments were aimed at reducing pollutant emissions, ambient concentrations, and ultimately adverse health outcomes. Objectives: As part of a comprehensive air pollution accountability study, we used a counterfactual study design to estimate the impact of mobile s...

Appropriately characterizing spatiotemporal individual mobility is important in many research areas, including epidemiological studies focusing on air pollution. However, in many retrospective air pollution health studies, exposure to air pollution is typically estimated at the subjects' residential addresses. Individual mobility is often neglected...

Background: Mechanisms underlying the effects of traffic-related air pollution on people with asthma remain largely unknown, despite the abundance of observational and controlled studies reporting associations between traffic sources and asthma exacerbation and hospitalizations. Objectives: To identify molecular pathways perturbed following traf...

Oxidative stress is a potential mechanism of action for particulate matter (PM) toxicity and can occur when the body’s antioxidant capacity cannot counteract or detoxify harmful effects of reactive oxygen species (ROS) due to an excess presence of ROS. ROS are introduced to the body via inhalation of PM with these species present on and/or within t...

Although short-term exposure to ambient ozone (O3) can cause poor respiratory health outcomes, the shape of the concentration-response (C-R) between O3 and respiratory morbidity has not been widely investigated. We estimated the effect of daily O3 on emergency department (ED) visits for selected respiratory outcomes in 5 US cities under various mod...

It is hypothesized that PM2.5 with high oxidative potential (OP) can catalytically generate reactive oxygen species (ROS) in excess of the body’s antioxidant capacity, leading to oxidative stress. Therefore, two advanced methods for conducting source apportionment, along with field experiments characterizing air quality, are used to identify the so...

Background: High-resolution metabolomics (HRM) is emerging as a sensitive tool for measuring environmental exposures and biological responses. The aim of this analysis is to assess the ability of high-resolution metabolomics (HRM) to reflect internal exposures to complex traffic-related air pollution mixtures. Methods: We used untargeted HRM pro...

Municipal solid waste (MSW) incineration has developed rapidly in China. However, the air pollution-related health risks attributable to MSW incinerators are still far from known. In this context, an MSW incineration emission inventory was compiled using plant-level activity data and localized emission factors. Subsequently, Gaussian plume model an...

Oxidative potential (OP) of particulate matter measures the ability of particles to catalytically generate reactive oxygen species while simultaneously depleting antioxidants, leading to oxidative stress and, in turn, inflammation in the respiratory tract and cardiovascular system. OP measurements have been linked with adverse cardiorespiratory end...

Determining how associations between ambient air pollution and health vary by specific outcome is important for developing public health interventions. We estimated associations between twelve ambient air pollutants of both primary (e.g. nitrogen oxides) and secondary (e.g. ozone and sulfate) origin and cardiorespiratory emergency department (ED) v...

Time-series studies are routinely used to estimate associations between adverse health outcomes and short-term exposures to ambient air pollutants. Poisson log-linear model with the assumption of constant overdispersion is the most common approach, particularly when estimating association between daily air pollution concentrations and aggregated co...

Introduction: The Dorm Room Inhalation to Vehicle Emissions (DRIVE2) study was conducted to measure traditional single-pollutant and novel multipollutant traffic indicators along a complete emission-to-exposure pathway. The overarching goal of the study was to evaluate the suitability of these indicators for use as primary traffic exposure metrics...

Introduction: The United States and Western Europe have seen great improvements in air quality, presumably in response to various regulations curtailing emissions from the broad range of sources that have contributed to local, regional, and global pollution. Such regulations, and the ensuing controls, however, have not come without costs, which ar...

Introduction: The Dorm Room Inhalation to Vehicle Emissions (DRIVE2) study was conducted to measure traditional single-pollutant and novel multipollutant traffic indicators along a complete emission-to-exposure pathway. The overarching goal of the study was to evaluate the suitability of these indicators for use as primary traffic exposure metrics...

Introduction: The United States and Western Europe have seen great improvements in air quality, presumably in response to various regulations curtailing emissions from the broad range of sources that have contributed to local, regional, and global pollution. Such regulations, and the ensuing controls, however, have not come without costs, which ar...

Background: Few epidemiologic studies have investigated health effects of water-soluble fractions of PM2.5metals, the more biologically accessible fractions of metals, in their attempt to identify health-relevant components of ambient PM2.5. Objectives: In this study, we estimated acute cardiovascular effects of PM2.5components in an urban popul...