Bret Andrews DO, NICHe (Neurologists Interested in Climate and Health) Beth Malow MD FAAN, Professor of Neurology and Pediatrics, Vanderbilt University Medical Center, NICHe

MGH, March 25, 2026

Climate Change and Brain Health: What We Know and What We Can Do

Beth’s Story/Climate Communication

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In talking with friends, colleagues, and patients…

First connect with your audience. What do they care about?

Then tell your story and share a simple message.

Warming is accelerating. 2024 warmest year ever.

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Source: Copernicus/ECWMF

Current increase:

1.5⁰ C (2.8⁰ F)

since pre-industrial

times.

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- World Meteorological Society

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Global temperatures since late 19^th century average

Global CO2 per NOAA

Flooding in Boston Area: �Dec 2022

NBC Boston

Wildfires

Wildfires are fueled by hotter temperatures

Wildfire smoke contributes to total PM2.5 (most toxic cause)�

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Massachusetts Wildfires� Fall 2024

Amazon Rainforest Wildfires 2024

9

2

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Analyzed 8.6 million births in CA form 2001-2019 linking records to ASD diagnoses and estimating wildfire-related PM2.5 exposures. Strongest odds of ASD were seen with intense wildfire episodes (≥35ug/m3).

Exposure to wildfire PM2.5 was assessed in KP Southern CA pregnancy cohort from 2006-2014

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Children exposed to 1–5 days of any wildfire PM2.5 during 3rd trimester had elevated risk of autism. The effect size was larger for wildfire PM2.5 > 3 μg/m3

Luglio et al.

My Story

Solastalgia and then 2013 Rim Fire…

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What’s Important: family, communities, health

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• Found local opportunities for advocacy,
• We can work with others to change the future
• Communication is key

Climate Change and Air Pollution:

Burning

Fossil

Fuels

(+Wildfires, burning biomass)

Greenhouse Gases

CO2, CH4(methane),

Anaesthetics

Air Pollution: contamination of the indoor or outdoor air by any agent that modifies the natural characteristics of the atmosphere (any chemical, physical or biological agent): WHO

*PAH= Polyaromatic Hydrocarbons, VOC= Volatile Organic Compounds

Health Effects,

Neurologic Dz

Climate Change Increased Heat

(Increased

wildfires)

Toxins PM2.5, PM10, NOx, SOx, O3 [VOCs, metals, others (CO2)]

Air Pollution

Air Pollution and Neurology Mechanisms?

CA Air Resources Board³

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- PM2.5 (small soot < 2.5 µm) and NO2 most researched

- PM2.5 particles penetrate deep lungs, may be absorbed.

- Injury mechanism to brain and other organs likely involves inflammation and oxidative stress and potentially transit with direct organ toxicity

Lungs

PM2.5

PM10

HumanHair

Sand

Air Pollution

Brain

Climate and Air Pollution�

Air Pollution is primarily from: Fossil fuel emissions (+ Wildfire smoke) Substantial health burden

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Ambient (Outdoor) Air pollution premature deaths: US ~ 90k - 200k /yr, World ~ 3.8 M/yr (~2.5-5x US auto accidents)

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Indoor + Outdoor AP: Worldwide ~6.7 M/yr (> COVID19 total deaths, 1/8th of all cause deaths)

Stroke + heart disease leading ~ ½ of that

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Caiazzo, Atmospheric Environment 2013, CDC Underlying cause of death Goodkind, PNAS 2019, Institue of Health Metrics and Evaluation 2016

WHO 2024 2005

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AP

Air Pollution and the Air Quality Index AQI

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24hr Air Quality Index is tied to the PM2.5 concentration

(nonlinear)

50 AQI = 9 µg/m³

100 AQI = 35 µg/m³

150 AQI = 55 µg/m³

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There is no safe lower level of air pollution

Air Pollution Neurological Effects: Stroke�

The burden of stroke worldwide is increased by at least 14%-20% by air pollution.

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Cohen A. CA. 2017. Global Burden of Disease Attributable to Air Pollution. Lancet

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^{WSO Stroke FACT Sheet}

Air Pollution Long Term PM2.5 and Stroke�

A meta-analyses of long term PM2.5 exposure: For each 10 µg/m³ increase in average PM2.5 exposure: (like AQI from 50 to 69)

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• All Stroke risk up by 13% (14 studies, RR 1.13, [1.11-1.15])
• Ischemic Stroke risk up 18% (5 studies, RR 1.18, [1.14-1.22])
• Ischemic heart disease mortality up by 23%, and MI up 8%

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Alexeeff SE. 2021. Long‐term PM2.5 exposure and risks of ischemic heart disease and stroke events: review and meta‐analysis. J Am Heart Assoc (14 studies) [RR of an incident ischemic stroke in the random effects meta‐analysis = 1.18 (95% CI, 1.14–1.22), with low heterogeneity among studies (I²=11.8%)]  US/Canada/Europe/Asia

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Short Term Air Pollution and Stroke

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Recent meta-analysis of exposure </= 5 days prior to stroke (110 studies, 18M incident strokes)

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Ischemic Stroke Risk Ratios show robust association:

• NO₂ 1.28 (1.21-1.36) = 28% incr
• CO 1.26 (1.21-1.32)
• SO₄ 1.15 (1.11-1.19)
• PM2.5 1.15 (1.13-1.17) = 15% incr
• PM10 1.14 (1.12-1.16)
• ------------------------------------------------

Toubasi A. 2023. Short-term Exposure to Air Pollution and Ischemic Stroke: A Systematic Review and Meta-Analysis. Neurology Asia~60% of studies, rest Europe and Americas) [short-term defined as exposure </= 5 days from onset of CVA] Asia predominant

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Air Pollution: Stroke By Proximity�

TRAP (Traffic Related Air Pollution)

Northern Manhattan Population with busy highway pollution exposure:

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Those living <100 m vs those >400 m from a major roadway had: 42% higher rate of ischemic stroke

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Kulick ER. 2018. Residential proximity to major roadways and risk of incident ischemic stroke in NOMAS(The Northern Manhattan Study). Stroke. (95% confidence interval, 1.01–2.02) HR 1.42 for <100m adjusted for SDH and CV risks, N=3287; median f/u 15yrs.

AP

Outdoor Air Pollution: 2nd leading cause of stroke disability worldwide:

WSO 2025

GBD 2021 Stroke Risk Factor Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol 2024

Stroke disability modifiable risk in DALYs (Disability Adjusted Life Years)

Air Pollution Neurological Effects: Dementia�

Meta-analysis of 20 cohort studies: 3% increase in dementia risk for every 1 ug/m3 increment in PM2.5 (like AQI from 50 to 53.)

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Study from UK: Those living <1000 m vs >1000 m from a major traffic road had:

13% higher risk of dementia

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Abolhasani E, et al. 2023. Air Pollution and Incidence of Dementia. Neurology

Li C, et al. 2023. Relationships of Residential Distance to Major Traffic Roads and Dementia Incidence and Brain Structural Measures. Health Data Science 500k UK

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M

Amyloid Plaque

Relation of dementia �to air pollution

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• Pink boxes: Study had positive results
• Red characters: Pollutants related to dementia

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Main findings:

• Pollutants with positive association:

PM2.5 > NO₂/traffic > O₃, SO₂, CO, black carbon

• 14/16 studies showed dementia associated to air pollution

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Delgado-Saborit, Sci Tot Env 2021

Air Pollution Neurological Effects: Parkinson’s disease�

Recent study of 21.6 million US Medicare patients found:

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The relative risk of PD dx was 56% greater for those exposed to long term median level of PM2.5 (40 AQI, 7 ug/m³) vs the lowest levels of PM2.5 exposure.

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Kryzanowski B, et al. 2023 Fine Particulate Matter and Parkinson’s Disease. Neurology

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Wildfire Smoke PM2.5 Effects: Mortality�

Qiu M. Wildfire Smoke Exposure and Mortality Burden in the US under climate change. Nature 9/2025:

• US wildfire PM2.5 related annual excess mortality estimated at 41,380 per year (2011 to 2020). Mostly >65 years.

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• By 2050, excess mortality to increase by >2/3rds (64-73%) if other sources of PM2.5 remain constant. (67,000 to 71,000/yr)

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Chen G. PM2·5 pollution: a global time series study in 749 locations. Lancet Planetary Health 2021

Wildfire PM2.5 smoke associated with >0.5% of all cause and >0.67% cardiovascular (including stroke) deaths

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Wildfire PM2.5 Neurological Effects: Stroke and CVD�

Wettstein Z. JAHA 2018

2015 ED visits from 8 California air basins: increased all cause cerebrovascular visits for all adults, especially those >/= 65 years. (RR1.22 [1.00,1.49] with dense smoke)

Alexeff SE, et al. JAHA 2/2025

Kaiser data from 2018, (3.2 million) showed positive association for cardiovascular (including stroke) for some air basins (Mendocino Complex Fire) with PM2.5 increase >35 ug/m³ vs </= 12ug/m³

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Hospital study from 15 States: 3 month avg increase in PM2.5 of 0.1ug/m³ associated with increased hospitalization relative risk for cerebrovascular disease of 0.1%. For 10ug/m³, that is an increased risk of 10%. (AQI of 50-69)

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Wei Y. Medium-term Exposure to Wildfire Smoke PM2.5 and Cardiorespiratory Hospitalization Risks. Epidemiology 2025

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Wildfire PM2.5 Neurological Effects: Dementia�

Elser H, et al. Wildfire Exposure and Incident Dementia JAMA Neurology 2024:

1.2 million S. California Kaiser cohort study, 2009-2019: 1 μg/m³ increase in the 3-year mean of wildfire PM2.5 exposure was associated with an 18% increase in the odds of dementia diagnosis. -RETRACTED- Due to diagnosis coding errors with PD patients, OR dropped from 1.18 to 1.12 and results became nonsignificant though the linear trend still held.

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Zhang B et al. Comparison of Particulate Air Pollution From Different Emission Sources and Incident Dementia in the US JAMA Internal Medicine 2023

Data from the US Health and Retirement Study (HRS), N=27,857, between 1998 to 2016: Dementia associated with increased PM2.5. Controlling for other sources, Agriculture (HR 1.13 [1.01-1.27]) and Wildfires (HR 1.05[1.02-1.08]) still robustly associated with increased dementia.

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Wildfires in North America reversing gains?�

• Since the mid 1980’s, increased extent x10, and severity x15 of fires in the Western US

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• These are expected increase 3x - 4x in extent and severity by 2050. (Bad seasons become normalized)*

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• Causes: Climate Change > Other (Drought w dryer + longer fire seasons > Winds, Hx of Fire Suppression, Human Habitation, and Pine Beetles)

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• This is a pattern unfolding widely in the Western US (and globally) which could reverse previous gains from the Clean Air Act and clean air pollution policies.

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* Parks AS. Intensifying fire season aridity portends ongoing expansion of severe wildfire in western US forests. Global Change Biology 2025.

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Indoor Air Pollution

1. Kashtan and Jackson. Nitrogen dioxide exposure, health outcomes, and associated demographic disparities… Science Advances. 2024

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Oven at 475°

Oven 350° + one stove burner on high, No Hood

• Moving to electric cooking, especially induction ranges, is more energy efficient with big health benefits Or at least use an outside ventilating hood if possible, or open windows and HEPA air purifier

Advice with Poor Air Quality for Patients and Caregivers:

Relevant Hx:

• Do they live very close (<500m) a major highway or other high pollution source?
• Do they have an outside venting fan?
• Gas or electric stove?

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Pollution Scenarios:

• Persistent exposure, eg close to major highway, port, or other high pollution sources: NO₂+ Particulates (PMs)

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• Periodic bad air quality days (>100 AQI): red flag days/ wildfire smoke: NO₂+ PMs/ PMs>>NO₂ (w wildfire)

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• Gas stove (NO₂> PMs)

Potential Advice:

• Consider moving (Persistent source)
• Use outside venting hood and all electric cooking if possible (NO₂)
• Use HEPA air purifier (PMs) 100% or PRN
• When outdoors, KN95 + one way valve (PMs)
• Follow your Air Quality Index through map.purpleair.com or airnow.gov

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Climate Change: Extreme Heat Related Deaths

• Extreme heat linked to at least 2,325/year ^1,2
• Significant upswing in the last 15 yrs, (since 2016).
• Heat-related mortality averaging >500,000 annually worldwide ³

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1. Howard JT, JAMA Open Network 2024.

2. Hassan I, et al. 2025. Annals of Internal Medicine

3. 2025 9th annual Lancet Countdown on Health and Climate Change report

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US stroke and heart related deaths from Extreme Heat could more than double by mid century on the current trajectory.

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• Kahtana SAM, Projected Change in the Burden of Excess Cardiovascular Deaths Associated With Extreme Heat by Midcentury (2036–2065) in the Contiguous United States 2023 Circulation
• 1651 to 4320 annual [162%, (>/=90 F), 0.05% per each added day]

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Extreme Heat and Ischemic Stroke

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Kono M, et al. Impact of rapid temperature fluctuations on acute stroke risk: a nationwide case-crossover study from 2001 to 2020 [Lancet, 4/2025 ] 1.1m from the NHIRD (Taiwan) (after adjustment Air Pollution and rainfall), TDI (Day to Day increase) >6 °C vs risk threshold, 2x AIS risk (OR: 2.173)

Zhu X, et al. Hourly Heat Exposure and Acute Ischemic Stroke [JAMA Netw Open, 2/2024] 82k China nationally 2019-21, 12C (56F), gradual increase AIS (acute ischemic CVA) risk up to extreme 33C (91F) cumulative (OR 1.88)

Chu L, et al. Ambient Temperature and Stroke Risk Among Adults Aged 18-64 Years: A Case-Crossover Study. [Journal of American College of Cardiology 10/2024] 1.05m Blue Cross Blue Shield 2016 to 22 increased risk with moderate and extreme heat, max risk (OR 1.4)

Alahmad B, et al. Extreme Temperatures and Stroke Mortality: Evidence From a Multi-Country Analysis. Stroke 7/2024 >49 countries, over 3.5 million AIS, 1979 to 2019: 2.2/1000 excess ischemic CVAs with extreme temps (2.5% of hottest days)

Multiple recent studies associate increase heat with stroke.

A recent review showed 2.2 excess stroke deaths per 1,000 with extreme heat days in over 40 countries.

Portea Medical

Extreme Heat and Dementia

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Alzheimer’s and related dementia patients (ADRD) increased heat wave related hospitalizations (1 day: 0.8/1000; or 4 days: 1.7/1000)

Delaney SW, et al. Extreme Heat and Hospitalization Among Older Persons With Alzheimer Disease and Related Dementias (ADRD) JAMA Netw, 02/3/25

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China study: Attributable fraction risk of dementia related deaths, was greater for nights than days at 1.4%

Gao Y. et al. Heat Exposure and Dementia-Related Mortality in China. JAMA Netw Open, 06/3/24

97.5% threshold,133k in China, 2013-2019,

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RXs for caregivers: Counseling re hydration, cooling strategies and cooling centers.

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Guidelines for Extreme Heat for Patients and Caregivers:

from Subramanian I, Saad A. Heatwaves and Neurodegenerative Disease. JAMA Neurology 2024 �

Neuro Infectious disease: Tic-borne infections

• Lyme disease (borreliosis)

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• Incidence increased 3-4x in 30 yrs
• Geographic range increasing
• Climate change contributes via milder winters

(extending tick range and active period)

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CDC

CC

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2001

2021

CDC

Climate and Behavioral Health

• Extreme heat impacts multiple papers:
• Irritability/aggression/domestic violence
• Depression
• Increased suicide
• Memory, attention, reaction time alterations
• Sleep changes additive

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• Climate Anxiety

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• Displacement: Trauma from Extreme Weather Events or Migration
• ​

�

ideas.ted.com

Climate Justice in US

Climate injustice:

Disproportionate effects on low-income communities and communities of color

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These vulnerable populations have greater health burden from air pollution:¹

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• US POC live 3.7x more often in a county with 3 or more failing grades on air pollution ²
• Annual PM2.5 exposure for US Blacks 12% > US Whites with higher associated mortality ³

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1. Jbaily, Nature, 2022. 2. 2024 State of the Air, American Lung Association 3. Morello-Frosch, NEJM, 2023

So Cal, Inside Climate News

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What One Can Do: Start with Food and Climate

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Agriculture’s greenhouse gas emissions are 18% of US total

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1. Reduce animal-based food:

Carbon footprint of animal-based food much higher

2. Reduce beef (+ lamb):

• Methane is a powerful greenhouse gas (GHG) [25x that of CO₂]
• Cows/ruminants contribute 12-19% of GHG world-wide, 4% of US GHG.^1,2
• Added benefit of improved health.

3. Reduce food waste and compost: In US, 38% of food is wasted, much by households

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1. Food and Agriculture Organization of the UN 2023 2. Xu X. Global greenhouse gas emissions. 2021 3. Mitloehner F. UCD. 2019

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CH₄

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• Fewer plane flights: (avoid first class and multiple stops)
• Electrify everything: our homes, workplaces and transportation – heat pumps and clean energy
• Help utilities/grids/storage move to clean energy: change your usage, support policy changes
• Join organizations working on climate change
• Vote for climate health and contact our reps.
• Tell our colleagues, families and patients
• Support climate health education and research

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Elect cleaner energy through your energy providers through a CCA or REC program: You don’t need to do solar first

Go Clean Green Electricity!

- Do you know where your electricity comes from? State sources for MA:

Total MA mix: 29% natural gas, 0% coal, 11% solar, 56% Imported (???)

- Boston Community Choice Electricity:

BCC Green 100 with100% renewable sources, is just 0.6 cents/kWh more than the std Eversource rate (avg about $4 more a month)

**This drives an increased supply of clean renewable energy replacing dirty sources. ��

CCA States, Climate Policy Dashboard 2025

We Can Do More Together – More Hope, More Opportunity Health is Our Lane!

• Our voices as physicians and health professionals, are highly respected

•We have the opportunity to be leaders on health consequences of air pollution and climate change

•We can talk to people: to our patients, colleagues, communities and policy leaders to build bridges – build a consensus that climate is a health issue and an affordability issue (nonpartisan) and should be a high priority for all Americans

•We are not alone: We can accomplish more working in groups and coalitions. Join NICHe, MSCCH, NCWG or a local physician group for opportunities.

•When we work together: this also can improve our mental health.

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What can we do, together?

• Identify one area to get involved in

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• Recognize we are trusted messengers

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• Communicate simply and often

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“Channel Outrage into Action”

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“Do what you can, with what you have, where you are”

-Teddy Roosevelt

Americans trust their doctors as an information source

Fall 2022

Engage with others, especially those with different viewpoints

• Stay hopeful, practice curiosity, and become a great communicator. Build trust..
• Focus on health – talk about pollution
• Emphasize impact on our kids, and our community
• Bring up economic cost and opportunity (job creation)
• Be open to innovative ideas �(market strategies)

NICHe: Neurologists Interested in Climate and Health

• Formed in early 2023 after publication of an editorial in the Neurology Journal
• Presented a letter to the AAN Board to take action on climate and brain health with over 300 signatures.
• Met with AAN Board President Carlayne Jackson and CEO Mary Post to discuss how the AAN could advocate for climate related brain health Jan 2024.
• Presented a seminar on Climate Change and Brain Health at AAN 2024 and again this year
• Presented multiple neurology grand rounds at US medical centers and to other neurological �societies, organizations and AAN sections.
• Please join our contact list for our newsletters, occasional updates and invitations to our meetings.

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Larry Junck, MD

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Bret Andrews, DO

Beth Malow, MD, MS, FAAN

Ali Saad, MD, FAAN

nichebrainhealth.com

Advocacy happens at multiple levels

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• Your patients
• Your trainees (or as a trainee…)
• Your health care system
• Your community
• Your state
• Your country
• Your world

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phreportcard.org/

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• Medical Society Consortium on Climate and Health
• European Academy of Neurology Environmental Task Force
• Global Green and Healthy Hospitals
• Healthcare without Harm
• Planetary Health Report Card
• Physicians for Social Responsibility
• Citizens’ Climate Lobby
• RepublicEN
• Climate Reality Project�� and more!

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See our Advocacy Links here: nichebrainhealth.com/what-we-can-do/

Join Our Contact List and More Information:

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Join our Contact List here (on our

NICHe website homepage): nichebrainhealth.com

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Contact Us:�Bret Andrews, DO: bretdandrews@gmail.com

Beth Malow MD, FAAN: beth.malow@vumc.org

Ali Saad MD, FAAN

Larry Junck, MD

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• Quarterly Newsletter and occasional messages
• Support Education, Research and Advocacy

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Winter 2026 Newsletter

Links Page and the Slides

Links Page:

https://docs.google.com/document/d/1cKqqLdGuCWhtCWPnNB7g_Haz_o8WuNqkppYwmX-4vZ4/edit?usp=sharing

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Slides Link:

https://docs.google.com/presentation/d/1rB7C_Aso-z8bHa9JV4d_dZhpO63Jcskc/edit?usp=sharing&ouid=105802387593048620381&rtpof=true&sd=true

END

-cardiovascular disease: stroke and heart

-neurodegenerative disease: AD, Parkinson’s

-neurodevelopment: autism/cognitive function

-birth outcomes

-lung disease: asthma and chronic lung dz

-cancer: meningiomas?*, lung, breast, prostate, colorectal, leukemias (benzene)

-motor neuron disease**

-kidney

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* Hvidtfeldt UA, et al. 2025 Ambient Outdoor Air Pollution and Risk of Tumors of the Central Nervous System. Neurology **Wu J. Long-Term Exposure to Air Pollution and Risk and Prognosis of Motor Neuron Disease. JAMA Neurology Jan 2026

Alexeeff SE, et al, 2023 Association of Long-term Exposure to Particulate Air Pollution With Cardiovascular Events in California, JAMA Netw Open

Wei Y, et al. 2024 Exposure-response associations between chronic exposure to fine particulate matter and risks of hospital admission for major cardiovascular diseases: population based cohort study. BMJ

Wei Y, et al. 2023. Additive effects of 10-year exposures to PM2.5 and NO2 and primary cancer incidence in American older adults. Environ Epidemiol

Cheng I, et al. 2019. Association between ambient air pollution and breast cancer risk: The multiethnic cohort study. Int J Cancer

Nyadanu, SD, et al. 2022 Prenatal exposure to ambient air pollution and adverse birth outcomes: An umbrella review of 36 systematic reviews and meta-analyses. Environmental Pollution

Landrigan PJ, et al. 2017. Air pollution and the kidney—implications for control of non-communicable diseases. Lancet

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Air Pollution Associated Disease:

Neurological Disease Associations: Temperature Rise and Climate Change

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• extreme heat
• increased ischemic stroke
• increased dementia
• neuroinfectious disease
• behavioral health

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�

AP

Climate Justice – the Global South (GS)

• The GS has overall contributed much less to total GHGs

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• The GS also suffers a greater burden from the consequences of climate change

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• GS often has much worse air pollution and health harm

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• GS has higher ischemic stroke, disability, and mortality rates. ¹

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1. Bo Y. Neurology. 2023.

Age Standardized Stroke Mortality Rate due to Particulates

Climate Change: Unprecedented Heat�

• 2024, record extreme heat events across the US and world, repeating in 2025
• Summer of 2022, >60,000 excess deaths due to European heat waves. Not prepared. Again in 2025, but this time more resilience measures.
• Vulnerable populations suffer more including those in urban heat islands, outdoor workers, children and the elderly

2025

2023 Balester, Heat related Mortality in Europe, Nature Medicine³⁴

2023 Vecellio. Greatly enhanced risk to humans…moist heat stress tolerance. PNAS⁷

NOA

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Both AP

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• 263 million cases and 600,000 deaths per year (WHO, 2020)
• Brain involvement often lethal, esp. in kids
• Conditions now more favorable for mosquitos
• New cases in summer of 2023 in TX & FL

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Other Increasing Mosquito Borne Diseases:

• Dengue
• Zika

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Malaria death rate in 2019.

Per Global Burden of Disease 2021

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Anopheles mosquito

CDC

Red blood cell with

malaria protozoan

Infectious disease: Malaria

Air Pollution: Also Cancer, Motor Neuron Disease?

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Wu J. Long-Term Exposure to Air Pollution and Risk and Prognosis of Motor Neuron Disease. JAMA Neurology Jan2026. 1463 Swedish patients with MND, per IQR increase in the 10-year average level, the odds ratio for PM2.5 was 1.21 (95% CI, 1.09-1.34) and for PM10, 1.29 (95% CI, 1.18-1.42)

Hvidtfeldt UA. Ambient Outdoor Air Pollution and Risk of Tumors of the Central Nervous System. Neurology 08/2025

Risk of Meningiomas for all Danish adults over 20 yo since 1991:

Adjusted Hazard Ratios for PM2.5 and UFP =1.10, and 1.12 for NO2

Wildfire Smoke Health Effects: Brain Tumors?

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Korsiak J. Long-term Exposure to wildfire smoke and cancer incidence in Canada Lancet Planetary Health 2022

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Canadians exposed to wildfire within 50 km in the past 10 years had a 4·9% (95% CI 2·8–7·1) relatively higher incidence of lung cancer than unexposed populations in adjusted models, and a 10% [2·6–17·9] relatively higher incidence of brain tumours

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Neurological consequences of a hot environment

• Multiple sclerosis:

Study shows increased presentation for acute care associated with high environmental temperature^1,2

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• Headache:

2 studies showed ongoing temperature increase associated with presentation with acute headache^3,4

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1. Elser et al, PLoS, 2021. 2. Louis et al, Neurology, 2022. 3. Mukamal et al, Neurology, 2009. 4. Vodonos et al, Cephalalgia, 2015.

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Elser H, et al. 2021. Anomalously warm weather and acute care visits in patients with multiple sclerosis. PLoS ⁴⁰ (95% CI’s: 1.025–1.063 and 1.010–1.054)

Januel E, et al. 2021. Fine Particulate Matter Related to Multiple Sclerosis Relapse in Young Patients. Front Neurol.⁴¹ (95% CI:1.01-1.46, p=0.039)

Louis S. 2022. Impacts of Climate Change and Air Pollution on Neurologic Health, Disease and Practice Scoping Review. Neurology⁵

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UNSPLASH

Brain involvement by MS evident on MRI

Save Climate Disasters: Who Pays?

NASA

LA, Jan 2025, ABC News

2024: US Costs ~ $150B (27 events) NOAA, NCEI (Natl Cntr Climate Info)

2025: LA Wildfires 65-130B Gallagher Re 2025 and UCLA Anderson Report, Li Z. 2025

SAVE: Indoor Air Pollution

Multiple sources of indoor air pollution, but the greatest contribution in most CA/US homes is NO₂ from gas stoves – they don’t exhaust outside:

- ~64% California households don’t use hoods (typically only 25-75% effective)²

- NO₂ associates with dementia, and stroke though PM2.5 associations are stronger

- NO₂ associates with asthma: CA childhood asthma incidence could drop by up to 20% if we completely stopping gas cooking ³

- Blacks/Hispanics// Native American disproportionately exposed to 20//60% more NO₂¹ (small homes up to 4x the exposure, often their homes don’t have hoods that ventilate outside, and outside air quality typically worse and comes in)

1. Kashtan and Rob Jackson. Science Advances. 2024 2. Zhao, Singer B. Intl J of Env Reas and Pub Health. 2020. 3. Gruenwald. Int J Enviorn Res Public Health. 2022.

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SAVE Neurocognitive Function and Air Pollution

Tang D, et al. 2014 Molecular and Neurodevelopmental Benefits to Children of Closure of a Coal Burning Power Plant in China. PLoS ONE

Research in Tongliang China by Columbia Mailman Public Health associated decreased exposure to air pollution in utero with improved developmental scores and higher levels of BDNF (brain derived neurotrophic factor).

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Parenteau, AM, et al. 2024 Clearing the air: A systematic review of studies on air pollution and childhood brain outgomes to mobilize policy change. Developmental Cognitive Neuroscience

40 peer-reviewed studies link varied child brian adverse outcomes (structural and functional) to air pollution

SAVE For the world’s largest companies, climate physical risks have a $1.2 trillion annual price tag by the 2050s

• Without adaptation, utilities are projected to bear the largest projected costs in the S&P Global 1200 index (Majority US Based)
• Extreme heat, water stress and drought combine to represent 91% of total costs with climate disasters only 9-10%

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SBC Global, March 10, 2025

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