About

Sara Dubowsky Adar, ScD, MHS, is a Professor of Epidemiology and Global Public Health at the University of Michigan School of Public Health. Her research utilizes modern principles of epidemiology, environmental health, exposure science, and biostatistics to characterize the impacts of environmental hazards on human health. Her primary focus is on the effects of air pollution and noise on healthy aging, with additional interests in global health, extreme weather events, and intervention strategies to improve health. She currently leads several large cohort studies examining the impacts of exposures on cognitive aging and dementia. Dr. Adar's educational background includes a Doctor of Science in Environmental Epidemiology from Harvard T.H. Chan School of Public Health, obtained in 2005; a Master of Health Science in Environmental Health from Johns Hopkins School of Public Health, earned in 1998; and a Bachelor of Science in Environmental Engineering from the Massachusetts Institute of Technology in 1996. Her research on how environments influence aging is cross-disciplinary, involving collaborations with environmental epidemiologists, climatologists, exposure scientists, economists, and demographers. She has contributed to understanding the relationship between air pollution, noise, and various health outcomes, including cardiovascular disease and cognitive decline. In addition to her research, Dr. Adar serves as an Associate Editor at Environmental Health Perspectives and is a member of the Review Committee for the Health Effects Institute. She has received awards such as the Sandra A. Daugherty Award for Excellence in Cardiovascular Epidemiology from the American Heart Association and the Excellence in Teaching Award from the University of Michigan School of Public Health.

Research topics

• Medicine
• Gerontology
• Environmental health
• Internal medicine
• Demography
• Psychiatry
• Psychology
• Pathology
• Audiology

Selected publications

• Air pollution and mortality in a University of Michigan amyotrophic lateral sclerosis cohort: a survival analysis

  Environmental Health · 2026-04-25

  articleOpen access

  Amyotrophic lateral sclerosis (ALS) is a rare, fatal, neurodegenerative disease. With limited treatment options, identifying modifiable risk factors that impact ALS survival is an important goal. Air pollution may be one such risk factor, yet the research on this topic is limited. We assessed survival for ALS patients at the University of Michigan Pranger ALS Clinic who were recruited to participate in a prospective cohort study between 2009 and 2022. Participants’ personal characteristics were linked with residential air pollutant levels of fine particulate matter mass (PM2.5), nitrogen dioxide (NO2), and ozone (O3), as well as several particle components, including black carbon (BC), nitrate, sulfate, and sea-salt (as a negative control) over follow-up. To assess the role of air pollution on ALS mortality we used time-dependent Cox proportional hazards models with days from diagnosis as the time axis, adjusted for potential confounders and co-pollutants. Across the 1,276 total years of person-time during follow-up (2.7 ± 2.5 years per participant) there were 329 deaths. In fully adjusted multi-pollutant models, one interquartile range (IQR) (2.1 µg/m3) higher 1-year average PM2.5 was associated with a 66% (HR 1.66 per IQR; 95% CI 1.03–2.68) increase in the hazard of death. The other pollutants were not associated with death in participants with ALS . This finding suggests a seven month longer median survival for a 2.1 µg/m3 decrease in 1-year average PM2.5, which is significant given that ALS lacks a cure and that existing treatments only extend survival by a few months.

  PublisherDOI

• Particulate air pollution from different emission sources, cognitive performance, and cognitive declines in India

  Environment International · 2025-09-27 · 1 citations

  articleOpen accessCorresponding

  • Evaluated associations of total and source-specific PM 2.5 with cognitive performance and decline. • Higher long-term PM 2.5 exposure was associated with accelerated cognitive declines. • PM 2.5 from residential combustion sources was robustly associated with steeper cognitive declines. • Reducing residential emissions may delay dementia onset and promote healthy aging in LMICs. Low- and middle-income countries experience some of the highest fine particulate matter (PM 2.5 ) exposures globally, with emissions from sources like residential combustion, industry, and transportation continuing to increase in many locations. While total PM 2.5 has been linked to cognitive decline, little is known about the relative importance of PM 2.5 from different emission sources, especially in low and middle-income settings. We used cognitive performance data from the 2017–2019 and 2022–2024 waves of the Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) and 5-year average PM 2.5 concentrations of total mass and mass from 9 emission sources estimated at each participant’s residential location using spatiotemporal models. We then quantified associations of these exposures with cognitive performance and decline using generalized estimating equation models accounting for survey weights and clustering, as well as adjusted for age, gender, individual and community-level socioeconomic status, urbanicity, place-related covariates, fuel type use, and co-pollutants. Among 5,699 participants (mean age: 70 ± 8 years), we observed total PM 2.5 concentrations ranging from 16 to 206 μg/m 3 . Higher concentrations of total PM 2.5 were not associated with cognitive performance at baseline but were associated with faster declines over time (−0.012/year per SD, 95 % CI: −0.021, −0.004). Among PM 2.5 from different sources, PM 2.5 from energy production, industry, and residential combustion were associated with steeper cognitive declines over time, whereas PM 2.5 from agriculture, transportation, wildfires, and windblown dust were associated with slower cognitive declines. The statistical evidence was strongest for associations with residential combustion and wildfires. Higher long-term total ambient PM 2.5 concentrations and those from residential combustion sources were associated with accelerated cognitive declines. This suggests that intervention in residential sources might reduce or delay the onset of dementia and promote healthier aging in low and middle-income settings.

  PublisherDOI

• Artificial outdoor light at night and depression in older adults in the USA, England, Northern Ireland, and Ireland

  Environment International · 2025-10-27

  articleOpen access

  • Artificial light at night (LAN) is linked to increased depression in older adults. • Data from four national aging studies in the US, UK, and Ireland were analyzed. • Associations by urbanicity varies across countries. • Associations remains adjusting for NO 2 and greenspace. Artificial Light at night (ALAN) is a potential environmental stressor for depression, but epidemiological evidence is limited. Cross-national surveys of aging were leveraged to examine LAN and depression. We used longitudinal aging surveys from the US (HRS; n = 20,868), England (ELSA; n = 9,848), Ireland (TILDA; n = 6,407), and Northern Ireland (NICOLA; n = 2,725). Depression was ascertained using Center for Epidemiologic Studies Depression Scale and dichotomized based on study-specific cutoffs. Annual mean outdoor ALAN exposure was estimated using satellite-derived nighttime light data (∼500 m resolution), then categorized using harmonized quartiles, based on cross-country population values (≤2.79, 11.69, and >23.93 nW/cm 2 /s). Poisson regression models estimated the prevalence ratios (PRs) of depression, adjusting for individual- and area-level factors. The prevalence of depression was highest in ELSA and HRS (24%), followed by NICOLA (14%) and lowest in TILDA (8%). The mean (SD) ALAN levels were 18.9 (9.0) nW/cm 2 /s in HRS, 13.4 (12.7) in ELSA, 10.4 (13.4) in TILDA, and 11.6 (10.3) in NICOLA. In fully-adjusted models, the highest ALAN quartile was associated with higher PRs of depression (reference: lowest quartile), in all surveys, with PRs (95% Confidence interval) of 1.40 (1.20–1.63) in HRS, 1.16 (0.98–1.38) in ELSA, 1.51 (1.08–2.10) in TILDA, and 1.79 (1.13–2.84) in NICOLA. The directions of the association were robust to adjustment for NO 2 , though attenuated. Findings from multiple countries suggest that outdoor ALAN exposure is associated with depression in older adults and highlight the value of international longitudinal aging cohorts for investigating the impact of environmental exposures on health.

  PublisherDOI

• Key research priorities in methodological approaches for measuring the exposome and studying its role in the development of dementia

  Alzheimer s & Dementia · 2025-11-01 · 1 citations

  articleOpen access

  There is growing recognition regarding the importance of the exposome, or the totality of exposures one experiences across the life course, in research on Alzheimer's disease and related dementias. However, the measurement of numerous exposures at once and over time, as well as modeling their effects on dementia risk, presents significant methodological challenges. Through community engagement and consensus-building processes integrating input from multidisciplinary panels of experts, we identified critical priority topics for methods used in studying links between the exposome and dementia risk, along with advances needed to address those priorities. We identified nine priority topics: high-dimensional and multimodal data, measurement error, harmonization across studies, mixtures of exposures, effect heterogeneity, exposure timing, cumulative exposures, reverse causation, and sample composition. This paper describes these priority topics and highlights areas where future research or the dissemination of existing methods could advance the state of existing science. HIGHLIGHTS: Inherent complexities central to the measurement and modeling of the exposome and its relationship to dementia pose methodological challenges. We identified nine priority topics, such as measurement error, mixtures of exposures, and cumulative exposures. Modeling approaches should consider complexity but provide useful simplifications when possible. Investments in the development and dissemination of innovative approaches and methodological guidance are needed.

  PublisherOA PDFDOI

• Long-term exposure to air pollution and incidence of asthma and chronic obstructive pulmonary disease among adults aged 50 years and older: the English Longitudinal Study of Ageing

  Journal of global ageing. · 2025-08-25 · 1 citations

  articleOpen access

  Air pollution is a recognised risk factor for respiratory diseases, but its long-term effect on obstructive lung diseases in older adults remains inconclusive. We investigated the associations between long-term air pollution exposure and asthma and chronic obstructive pulmonary disease (COPD) incidence in 11,391 respondents (aged ≥ 50 years) in the English Longitudinal Study of Ageing, recruited in 2002–03 and followed up to 2017 for new asthma and COPD diagnoses or hospital records. Annual mean levels of fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ) and ozone (O 3 ) with a one-year lag were assessed at respondents’ residential addresses. Time-varying Cox models adjusted for confounders were used and effect modifiers were tested. Over the 15 follow-up years, we observed 343 asthma diagnoses, 531 COPD diagnoses and 236 COPD hospitalisations. PM 2.5 was associated with asthma and COPD diagnosis and COPD hospitalisations. O 3 was associated with COPD diagnosis and hospitalisation. Stronger associations of PM 2.5 with asthma diagnosis were observed in ever-smokers, and stronger associations of PM 2.5 and NO 2 with COPD hospitalisation were observed in people aged 65+ and those in deprived areas; stronger associations of O 3 with COPD hospitalisation were observed in men. These findings underscore the significant risk of air pollution exposure in developing asthma and COPD in adults, highlighting the need for further studies to strengthen the evidence and identify susceptible populations.

  PublisherDOI

• Memory trajectories before and after a negative wealth shock, the United States Health and Retirement Study, 1998-2020

  American Journal of Epidemiology · 2025-12-06

  articleOpen access

  The potential for a bidirectional relationship between the experience of a negative wealth shock (a loss of ≥75% in total household wealth over 2 years) and accelerated memory decline among mid-to-later-life adults in the United States (US) remains unclear. We used population-based longitudinal data on 14 969 adults aged ≥51 in the US Health and Retirement Study from 1998 to 2020. One in 3 participants in this cohort experienced a negative wealth shock over the 22-year follow-up period (5184/14969, 34.6%). Participants who experienced a negative wealth shock had faster aging-related memory decline in the years before the shock than their counterparts who did not experience a negative wealth shock (an additional 0.04 standard deviation [SD] units per decade; 95% CI, -0.07 to -0.01) and an acute drop in their level of memory function concurrent with the negative wealth shock (-0.08 SD units; 95% CI, -0.10 to -0.05), yet slower memory aging after the negative wealth shock (0.04 SD units per decade; 95% CI, 0.01 to 0.06). We recommend strategies to support healthy memory aging of the large share of middle-aged and older US adults who are at risk of experiencing a negative wealth shock.

  PublisherOA PDFDOI

• Changes in marital and health status as risk factors for a subsequent negative wealth shock: A population-based longitudinal study in the United States, 1995–2020

  Social Science & Medicine · 2025-03-07 · 3 citations

  articleOpen access
  PublisherOA PDFDOI

• Defining methodologic and other core competencies for PhD-level training in epidemiology

  American Journal of Epidemiology · 2025-04-07

  article

  In this manuscript, we present the results of a series of workshops convened in conjunction with the 2023 Society for Epidemiologic Research annual meeting. The overall objective of the workshops was to develop a set of core competencies for PhD students in epidemiology. The topics presented in the list of competencies are organized using a framework similar to many graduate programs in epidemiology, proceeding from basic to advanced topics. Given the breadth of substantive topics in the fields of epidemiology and public health, this list of competencies focuses on methodologic topics that are relevant to all students, regardless of research interest. The final topic lists were developed based on discussions including a large and diverse group of epidemiologists with different areas of expertise. By creating this resource, we aim to facilitate training of future generations of epidemiologists.

  PublisherDOI

• Modeling approaches for estimating the effects of risk factors using longitudinal lifecourse exposure data in dementia research

  Alzheimer s & Dementia · 2025-11-30

  article

  Longitudinal data on risk factors at different ages across the lifecourse are essential for gaining important insights into how the timing and accumulation of exposure to risk factors influence the risk of Alzheimer's disease and related dementias (dementia). With increased interest in the exposome and lifecourse research questions, there have been commensurate increases in data sources and methodological approaches for answering these questions using empirical data. Methodological approaches developed within specific disciplines have largely remained within disciplinary silos, despite their potential for broader applications. By enumerating these approaches in a single place, we aim to expand discovery in lifecourse dementia research and help investigators align their research questions with appropriate analytic methods. In doing so, we seek to guide methodological decision-making and ensure that researchers use appropriate statistical tools to answer important questions about the exposome and lifecourse risk factors for dementia. HIGHLIGHTS: Longitudinal exposure data are valuable for exposome and lifecourse research on dementia. Multiple methodological approaches exist to analyze such data, with different assumptions, advantages, and disadvantages. Some methodological approaches have been used predominantly in specific disciplines but may have wider utility. Additional research is needed to integrate added complexity from the co-occurrence of multiple exposures into existing methods. Comparisons between methods help researchers make informed decisions on the appropriate method for a specific research question.

  PublisherDOI

• Insights into bridging disciplines and building measures from the Gateway Exposome Coordinating Center workshop

  Nature Aging · 2025-07-08 · 2 citations

  articleSenior author
  PublisherDOI

Recent grants

• Characterizing the Respiratory Microbiome Via a Novel, Non-Invasive Technique

  NIH · $426k · 2016–2019

Frequent coauthors

• Joel D. Kaufman

  University of Washington

  105 shared

• Adam A. Szpiro

  University of Washington

  71 shared

• Lianne Sheppard

  University of Washington

  51 shared

• Jennifer D’Souza

  University of Michigan–Ann Arbor

  39 shared

• Ana V. Diez Roux

  Drexel University

  33 shared

• Kenneth M. Langa

  Health Services Research & Development

  33 shared

• Timothy V. Larson

  University of Washington

  32 shared

• Jennifer Weuve

  Boston University

  29 shared

Awards & honors

• Sandra A. Daugherty Award for Excellence in Cardiovascular E…
• Excellence in Teaching Award from the University of Michigan…