Publications

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2019
Aguilera, R, Gershunov A, Benmarhnia T.  2019.  Atmospheric rivers impact California's coastal water quality via extreme precipitation. Science of the Total Environment. 671:488-494.   10.1016/j.scitotenv.2019.03.318   AbstractWebsite

Precipitation in California is projected to become more volatile: less frequent but more extreme as global warming pushes midlatitude frontal cyclones further poleward while bolstering the atmospheric rivers (ARs), which tend to produce the region's extreme rainfall. Pollutant accumulation and delivery to coastal waters can be expected to increase, as lengthening dry spells will be increasingly punctuated by more extreme precipitation events. Coastal pollution exposes human populations to high levels of fecal bacteria and associated pathogens, which can cause a variety of health impacts. Consequently, studying the impact of atmospheric rivers as the mechanism generating pulses of water pollution in coastal areas is relevant for public health and in the context of climate change. We aimed to quantify the links between precipitation events and water quality in order to explore meteorological causes as first steps toward effective early warning systems for the benefit of population health in California and beyond. We used historical gridded daily precipitation and weekly multiple fecal bacteria indicators at similar to 500 monitoring locations in California's coastal waters to identify weekly associations between precipitation and water quality during 2003-09 using canonical correlation analysis to account for the nested/clustered nature of longitudinal data. We then quantified, using a recently published catalog of atmospheric rivers, the proportion of coastal pollution events attributable to ARs. Association between precipitation and fecal bacteria was strongest in Southern California. Over two-thirds of coastal water pollution spikes exceeding one standard deviation were associated with ARs. This work highlights the importance of skillful AR landfall predictions in reducing vulnerability to extreme weather improving resilience of human populations in a varying and changing climate. Quantifying the impacts of ARs on waterborne diseases is important for planning effective preventive strategies for public health. (C) 2019 Elsevier B.V. All rights reserved.

2018
Vashishtha, D, Sieber W, Hailey B, Guirguis K, Gershunov A, Al-Delaimy WK.  2018.  Outpatient clinic visits during heat waves: findings from a large family medicine clinical database. Family Practice. 35:567-570.   10.1093/fampra/cmy013   AbstractWebsite

Introduction. The purpose of this study was to determine whether heat waves are associated with increased frequency of clinic visits for ICD-9 codes of illnesses traditionally associated with heat waves. Methods. During 4 years of family medicine clinic data between 2012 and 2016, we identified six heat wave events in San Diego County. For each heat wave event, we selected a control period in the same season that was twice as long. Scheduling a visit on a heat wave day (versus a non-heat wave day) was the primary predictor, and receiving a primary ICD-9 disease code related to heat waves was the outcome. Analyses were adjusted for age, gender, race/ethnicity and marital status. Results. Of the 5448 visits across the heat wave and control periods, 6.4% of visits (n = 346) were for heat wave-related diagnoses. Scheduling a visit on heat wave day was not associated with receiving a heat wave-related ICD code as compared with the control period (adjusted odds ratio: 1.35; 95% confidence interval: 0.86-1.36; P = 0.51). Discussion. We show that in a relatively large and demographically diverse population, patients who schedule appointments during heat waves are not being more frequently seen for diagnoses typically associated with heat waves in the acute setting. Given that heat waves are increasing in frequency due to climate change, there is an opportunity to increase utilization of primary care clinics during heat waves.