Environmental Drivers of Respiratory Disease: A District Level Analysis

Air pollution and climate-related stressors are increasingly important concerns for respiratory health, especially in settings with unequal environmental exposure and healthcare capacity. This study evaluates an interpretable machine learning framework for predicting respiratory disease rates and air-quality status using structured country-level weekly data. Two supervised learning tasks were considered: regression of respiratory disease rate per 100,000 population and binary classification of air-quality status. Nine regression models and nine classification models were compared using nested cross-validation. Model interpretation was conducted using SHAP values, and subgroup analysis was performed across income levels and geographic regions. The results showed that PM2.5 concentration was the dominant predictor of respiratory disease rate, with linear and regularized linear models achieving the strongest regression performance. For air-quality classification, models achieved high balanced accuracy when PM2.5 was included, but performance decreased substantially when PM2.5 was removed, indicating strong dependence on pollutant-related information. SHAP analysis showed that, without PM2.5, socioeconomic and meteorological variables such as GDP per capita, precipitation, and healthcare access became more influential. Subgroup analysis showed similar aggregate regression error across income groups, but PM2.5 contributed more strongly to predictions in lower-middle-income countries. These results show that model accuracy alone is not sufficient for climate-health prediction. Interpretable models can help identify dominant pollution-related signals, test whether results depend on key pollutant variables, and show whether prediction patterns differ across socioeconomic groups.

Childhood asthma is a common illness exacerbated by air pollution as well as meteorological and neighborhood-level socioeconomic factors. Modeling asthma exacerbation (AE) in large spatiotemporal datasets requires disentangling impacts from multiple contributors. In this case study, we compared three techniques that balance predictive power with interpretability to predict AE in Hampton Roads, a coastal Virginia region comprising 7 cities and over 1.5 million people. After collating ambient air pollution measurements, weather data, and measures of neighborhood opportunity, we modeled zip code-level acute AE visits to a regional children's hospital and affiliated providers from 2018-2023. Generalized linear models (GLM) provided a baseline while neural networks (NN) served as a maximally predictive target. To bridge between statistical models and deep learning, we developed a framework based on sparse dictionary learning to identify and interpret parsimonious nonlinear interacting equations. After comparing each model's predictive performance, we estimated relative risks for AE due to input exposure variables and found consensus across frameworks. Our work links statistical and interpretable machine learning models to highlight possible synergistic interactions influencing AE, and may enable future studies to guide public health interventions in coastal Virginia.

Air pollution regulation is central to urban public health governance, but estimating its effects is difficult because policies are implemented non-randomly and pollution trajectories are shaped by meteorology, socioeconomic change, temporal trends, and overlapping interventions. This study develops an uncertainty-aware Bayesian deep learning framework to estimate the aggregate effect of air pollution regulations on PM$_{2.5}$ concentrations in London from 2010 to 2020. The framework integrates daily PM$_{2.5}$ observations from Inner London monitoring stations, meteorological covariates, annual socioeconomic indicators, month-of-year and day-of-week indicators, and daily regulation status data for 32 policy measures. A Bayesian LSTM captures temporal dependencies in environmental and socioeconomic covariates, Bayesian embedding layers represent temporal and regulation status inputs, and a regulation status prediction branch supports propensity score-based adjustment for non-random policy implementation. Regulatory effects are estimated by comparing observed PM$_{2.5}$ concentrations with counterfactual predictions under a hypothetical no-regulation scenario, with uncertainty summarized across repeated Bayesian training runs and bootstrap resampling. Results show that London's regulations were associated with an average PM$_{2.5}$ reduction of 1.88 $μ$g/m$^3$, a relative reduction of 12.35%, with a 95% confidence interval of 1.64-2.12 $μ$g/m$^3$. Estimated effects were limited before 2013, became clearer from 2013 to 2017, and were strongest in 2018 and 2019. The findings suggest that sustained and cumulative regulatory interventions contributed to measurable improvements in London's air quality. This study demonstrates how uncertainty-aware causal AI can support environmental accountability, public health protection, and evidence-based governance for environmental decision-making.