The etiology and transmission of bacterial diarrheal pathogens is complex, making evaluating the association between extreme climate and diarrheal illnesses in North America challenging. Changes in climate may impact the survival, reproduction, and distribution of pathogens that cause diarrheal illness. Evidence supports the hypothesis that reproduction, survival, and transmission ability of bacterial pathogens that cause diarrheal illness, are heavily influenced by environmental conditions such as heat and precipitation and will vary by region. Diarrheal illnesses have historically increased during seasons characterized by extreme heat and precipitation, which can increase bacterial reproduction and transmission to surface water and crops. Although, we still do not know the specific mechanisms for the increased risk of diarrheal illness associated with extreme climatic events. Extreme heat and precipitation events are occurring more frequently across North America and are predicted to further increase in frequency and duration over the next century. Historically, extreme climatic events have created more clustered disease outbreaks in nontraditional places and times. As extreme climate events continue to increase in North America, bacterial pathogens that cause diarrheal illness such as Campylobacter, E.coli, non-typhoidal Salmonella, and Shigella, are expected to become more prevalent representing a public health concern. The objective of this research was to evaluate the association between extreme climate (heat and precipitation) and the risk of four commonly reported bacterial diarrheal illnesses between 2000-2016 in North America, while also taking into account population density, and urbanicity. This knowledge will help us to better understand and prepare for future diarrheal illnesses and outbreaks during extreme climate events.