From the Blue Ridge Mountains to the Atlantic coast, North Carolina's geography does more than shape its landscape. It may also influence the health risks people face.
At Duke University School of Medicine, researchers are combining climate data, geographic information, and real-world health records to better understand how environmental conditions affect health and why some communities face greater risks than others.
For João Ricardo Nickenig Vissoci, PhD, assistant professor of emergency medicine, one key question is how rising temperatures affect rural Carolinians, where outdoor work is common and access to air conditioning may be limited.
Third-year medical student Sakshi Chopra is examining why skin cancer risk varies across North Carolina. Her research explores whether environmental and geographic factors help explain differences found in the state's mountain and coastal regions.
Their projects, supported by the School of Medicine’s Climate and Health Research Initiative, share a larger idea: Health risks are shaped not just by who we are, but by where we live.
Extreme Heat
A heat warning might mean one thing in an urban neighborhood with widespread air conditioning and something very different in a rural community where people work outside and have limited places to cool down.
That is the problem Vissoci wants to better understand.
“The community with lower temps but limited access to air conditioning may actually face greater health risks,” said Vissoci, co-director of the Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center.
In September he will launch the Rural Carolinas Observatory for Heat Early Warning and Health Resilience which will combine high-resolution weather data with ambulance calls and emergency room records and community risk factors to identify when heat becomes dangerous in rural communities.
The goal is not to simply issue better warnings. The project will identify community needs, develop heat thresholds by defining what “too hot” looks like in their area, and work with residents and local partners to design ways to respond.
The approach builds on North Carolina’s existing health-based warning system. But Vissoci said those thresholds may not capture the realities of rural communities.
Because weather stations are often concentrated around airports and cities, they may not fully capture conditions in rural areas, where temperatures can differ and residents often have less access to air conditioning, emergency care, and other resources, he added.
The research team will work with emergency medical services, public health agencies, community organizations and other partners to develop response protocols and a Rural Health Playbook for communities, health care providers, health systems and policymakers.
The long-term goal is to treat extreme heat as a public health threat, Vissoci said, much like hurricanes and other dangerous weather events. The researchers hope the North Carolina model can eventually be adapted elsewhere.
Mapping Melanoma Risk
Chopra’s research began after she met a patient in dermatologist Michelle Pavlis, MD,’s pigmented lesion clinic at Duke Health. Pavlis is an expert in early melanoma detection who oversees melanoma surveillance at the Duke Cancer Institute.
The patient had no family history of melanoma, a type of skin cancer, or obvious signs of excessive sun damage. Yet she was diagnosed with an aggressive, advanced melanoma that had gone undetected.
For Chopra the case raised a bigger question: What if melanoma risk isn’t only about a person’s biology or behavior? What if place matters too?
That question led her to develop a melanoma vulnerability index that looks at risk through a geographic lens.
Researchers are combining North Carolina Cancer Registry data with information on ultraviolet radiation, temperature, rurality, age and socioeconomic conditions. Using increasingly detailed geographic data, they are looking for communities where melanoma rates may be unusually high.
Early findings suggest a bimodal pattern, with higher melanoma incidence in western North Carolina and coastal areas. Sun exposure could help explain the coastal pattern. In the mountains, altitude, outdoor recreation or access to specialty care could play a role, Chopra said.
“There are so any patients we come across clinically who don’t really have any obvious risk factors but still present with aggressive, invasive disease,” she said.
The amount of ultraviolet radiation a person gets from the sun or tanning beds is a well-known risk factor for skin cancer.
But Chopra and her collaborators are asking whether other environmental conditions including temperature, air quality, pollution, soil and water quality might also help explain why risk varies from one place to another.
The next step is working with local primary care practices, dermatology clinics and and patients to find out what'sbehind these geographic differences.
The team aims to create a melanoma prevention toolkit for high-risk communities and eventually develop a tool that helps doctors predict a person’s risk based on where they live and environmental factors.
Together,the projects reflect a shift in climate and health research toward understanding climate risks at thecommunity level and using thatdata to prevent health problems before they start.