ACHD Air Pollution and Health Investigations. LuAnn Brink, Ph.D., Chief Epidemiologist August 23, 2018

Transcription

1 ACHD Air Pollution and Health Investigations LuAnn Brink, Ph.D., Chief Epidemiologist August 23, 2018

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4 140 Number of unconventional natural gas wells permitted and drilled in Allegheny County over time: 120 Number of permits or wells Wells Drilled Wells Permitted 4

5 Deer Lakes sampling, 6/ to 4/ Reference concentration= 9.39 ppb 5

6 6 Imperial Pointe sampling, 3/12/14 to 5/7/ /12/2014 4/17/2014 5/5/2014 5/29/2014 6/16/2014 6/28/2014 7/16/2014 8/3/2014 8/27/2014 9/8/2014 9/26/ /14/2 11/15/2 12/1/ /19/2 1/6/2015 1/24/2015 2/11/2015 3/19/15** 4/6/2015 4/24/2015 5/12/2015 6/5/2015 6/17/2015 7/5/2015 7/23/2015 8/16/15** 9/3/2015 9/21/ /21/15** 11/8/ /26/2 12/14/2 1/1/2016 1/25/16** 2/12/2016 3/7/2016 3/25/2016 4/12/2016 5/6/2016 5/24/2016 6/11/2016 7/11/16** 7/29/2016 8/22/2016 9/9/2016 9/27/ /27/2 11/26/2 12/26/2 1/19/2017 2/18/20 3/8/2017 3/26/2017 4/25/20 Benzene concentration Fracking Drilling Site Construction Production

7 Purpose To explore the air quality and health effects of a community before and after coke plan closure (Shenango Coke Works) Closed January 7, 2016 To compare air quality and health effects of study area with a control community during same time period 7

8 Background Shenango Coke Works 2014 Located on Neville Island Fourth largest Volatile organic carbon (VOC) emitter Fifth largest SO 2 emitter 8 th largest PM 2.5 emitter Fifth in NO x emissions Largest methane emitter

9 ACHD initiatives Started monitoring VOCs in February 2015 in reaction to citizen complaints 8 monitors were positioned (1 monitor remains) Benzene, Toluene, Ethylbenzene, m-p-xylene, O-xylene, N-hexane Plant closed in January 2016 Continue to monitor for fine particulates (PM2.5) and H 2 S through to monitor changes after plant closure

10 Placement of VOC monitors in the North Boroughs area

11 Pollutants with health effects Particulate matter-pm 2.5 (even within regulatory limits) is associated with Acute and chronic cardiovascular events (Brook, Circulation, 2010) Acute and chronic respiratory events (Requia, AJPH, 2017) Lung Cancer (Hamra, EHP, 2014, IARC) Benzene (even within regulatory limits) is associated with Cancer (leukemia) (Snyder, Int J Environ Res Public Health. 2012) Low birth weight and neural tube defects (Porter, Env Health, 2014; Lupo, EHP, 2011)

12 Study design Natural experiment Measure air pollution levels and health effects before and after closure Advantage: have same population before and after Disadvantage: other things change over time Control for other factors Use of control populations that did not experience the change of interest Could be a change in environment that affects a larger area or a change in health outcome that effects the entire population

13 Meteorological comparison for 2015 to 2016 at the Avalon monitoring site

14 Meteorological comparison for 2015 to 2016 at the Avalon monitoring site

15 RESULTS 15

16 Inhalation References for compounds concentrations found in North Boroughs based on community monitors Maximum Concentrations Found (2 week sampling periods, in ppbv) Compounds tested Inhalation Reference Concentration (RfC)* (converted to ppb) Critical Health Effect* Carcinogenic Classification* Shenango Active Shenango Closed Benzene 9.39 Decreased blood cell count A - human carcinogen Toluene Neurological effects Inadequate data Ethylbenzene Developmental toxicity D - not classifiable m,p-xylenes 23 Impaired motor coordination Inadequate data o-xylene 23 Impaired motor coordination Inadequate data Naphthalene 0.57 Damage to the lining of the respiratory system C - possible human carcinogen ND ND Styrene Damage to the nervous system NA ND ND n-hexane Damage to the nervous system Inadequate data

17 Particulate Matter comparison from 2015 to 2016 Fine particulate matter (2.5 micrometers or less) decreased approximately 12% from 2015 before closure to 2016 after closure. This data is retrieved from the nearest monitoring site, located across the river from the Shenango site. Meteorological data from this monitoring site is very similar for 2015 and 2016, which reinforces incentive for comparison.

18 Benzene comparison from 2015 to 2016 A 37% decrease in Benzene has been observed since Shenango closed for all sites in the study. A 52% decrease was the greatest decrease for all sites in this study, where the maximum concentration for all sites of 1.52 ppb was seen as well (site CM4, nearly directly across the river from Shenango) Toluene, Ethylbenzene, Xylenes, Napthalene, Styrene, and Hexane were also sampled for, but results are currently inconclusive or insignificant.

19 Comparison Communities North Boroughs Harrison Area (unexposed control) Clairton area (exposed control) & 15037

20 Social factors in communities of interest Exposure Zip Code Population % 65 and over Poverty % Nonwhite PM 2.5 (2015) PM 2.5 (2016) PM 2.5 % change (15-16) Exposed , % 7.50% 11.20% % Unexposed Control Exposed Control , % 7.60% 7.60% , % 11.70% 4.20% % , % 9.40% 5.80% , % 7.70% 21.20% % , % 7.40% 3.30% % 20

21 Pollutant levels North Boroughs Liberty Borough Clairton Harrison Year PM 2.5 µg/m 3 Benzene ppb H 2 S ppm Have daily PM 2.5 measurements 21

22 Daily PM Clairton area North Boroughs Lowest Highest Lowest Highest 1.3 µg/m µg/m µg/m µg/m 3 Oct 4, 2015 Dec 7, 2015 Oct 3, 2015 Dec 7, µg/m 3 Sep 30, µg/m 3 Jan 25, µg/m 3 Sep 29, µg/m 3 Jan 8,

23 Why acute health effects? If we try to look at long term health effects, we will be setting ourselves up for failure to find any effect The exposure ended in January 2016, and even for childhood cancers with a fairly short latency period (minimum of two years before any expected cancer could occur) A deficit of cancer would be impossible to note at this point because the exposure still existed just 25 months ago. Occurrences of cancer attributable to exposure to coke oven gas in North Boroughs will be potentially just starting to occur. However, births to moms exposed during pregnancy last occurred in October Unexposed (comparison) births started in November 2016 and continue. We need to have final birth certificates through January 2018 (as monitoring continued through March 2017) before making a comparison.

24 Outcomes of interest hospitalizations and ED visits Cardiovascular Disease Acute myocardial infarction (heart attack) Cardiac arrhythmia Cerebrovascular disease (stroke) Heart failure Ischemic heart disease Peripheral vascular disease Respiratory Asthma COPD

25 Hospitalizations for circulatory system diseases by exposure status, 2015 and 2016 Exposure Zip Code Age-Adjusted Rate per 100, (95% CI) Age-Adjusted Rate per 100, (95% CI) Exposed ( , ) ( , ) Unexposed Control ( , ) ( , ) Exposed Control ( , ) ( , )

26 ED Visit rates (per 100,000) Exposure CVD2015 (95%CI) CVD2016 Resp 2015 Resp 2016 Injury 2015 Injury 2016 Exposed 9,388 (8,986-9,802) 6,899 (6,551-7,259) 10,216 (9,798-10,650) 6,344 (6,011-6,692) 7,173 (6,819-7,539) 10,297 (9,878-10,730) Exposed Control 3,760 (3,537-3,992) 4,032 (3,801-4,272) 4,825 (4,588-5,104) 4,840 (4,588-5,104) Unexposed Control 5,775 (5,490-6,070) 5,931 (5,643-6,229) 7,485 (7,163-7,817) 7,674 (7,349-8,010)

27 Number of outcomes ED visits North Boroughs CVD North Boroughs Respiratory Clairton CVD Clairton Respiratory North Boroughs CVD North Boroughs Respiratory Clairton CVD Clairton Respiratory

28 Previous studies natural experiments Friedman 2001 Atlanta Olympics Compared 17 Olympic days with 4 week periods before and after 11-46% change in acute asthma events (ED+hosp) during Olympic period Associated with a significant decrease in ozone/traffic Pope 1989 Utah When PM 10 < 150 µg/m 3, monthly hospitalizations for respiratory disease rate was 58.6, and when PM 10 > 150, there were hospitalizations When mill open (PM 10 =90 µg/m 3 ), there were 302 visits in winter, and when closed (PM 10 =51 µg/m 3 ) it was

29 Social stressors exacerbating health effects of air pollution Schmool, 2014 (NYC) Found that the effect of NO 2 on asthma was modified by social stressors (crowded conditions and poor access to resources) Stenlund 2009 (Sweden) Respondents perceived a higher risk of environmental hazards before plant shutdown rather than after Respondents were more annoyed by industrial odors before plant shutdown 29

30 Case crossover analyses Compares the concentration of air pollution on case day with pollution levels on 3 control days matched by day of week when no event occurred Incorporates lag allowing for time for the body to react to the challenge of the pollutant Tested for both North Boros and Clairton area and combined using the monitor closest to community to define daily air pollution, results controlled for temperature Compared the effect in each community Compared the effect across years

31 Case crossover literature Talbott 2014 (National study of hospitalizations) New York and New Jersey showed maximum associations of cardiovascular disease hospitalization and air pollution, with 1.2% increases with increase of 10 ug/m3 of PM2.5 Fan 2017 Meta analysis of asthma ED visits incidated an increase of 1.7% in adults and 2.8% in children associated with a 10 ug/m3 increase in PM2.5 31

32 Significant findings Cardiovascular disease emergency department visits 2015 Both Years Clairton 3 day lag: ( ) 1 day lag: ( ) 3 day lag: ( ) Both Communities 3 day lag: ( ) 3 day lag: ( )

33 Significant findings Respiratory disease emergency department visits North Boroughs Both Communities 2015 Both Years 3 day lag: ( ) 3 day lag: ( ) 3 day lag: ( )

34 Conclusions There was a modest decrease in the concentration of fine particulate matter after the plant closure A similar scale decrease was seen in an exposed control community Notable decrease in benzene and a modest decrease in hydrogen sulfide after closure in study area Benzene decrease was not seen in exposed control community A greater decrease in H2S was noted in exposed control community No change in hospitalization rates for study area or control areas across years of interest Decrease in ED visits noted largely outpaces changes noted in most similar studies Possible modification with stress 34

35 Case-crossover conclusions Associations in both areas of interest (study and exposed control) Different acute health outcomes, both associated with exposure to air pollution Consistency of association/s Strength of association increases when you focus on the community of interest and the time during which exposure was higher -- although sample size decreases A difference in age distribution across communities may explain differences in outcomes There may be a threshold at which there is an effect, as evidenced in the difference in effect between years, during which pollution decreased in both areas 35

36 Limitations ED visits are more nonspecific than hospitalization discharge diagnoses Populations are slightly different in Exposed and Control areas Do not have objective measures of the components of PM2.5 Do not understand the role of stress in chronic disease exacerbations 36

37 Future Studies/Questions Is there an association with geographic and temporal information from Smell Pittsburgh? Compare PM2.5 levels on case and control days in each community and each year 37

38 Acknowledgements ACHD Environmental Health Jim Kelly Jayme Graham David Cobb Tony Sadar Shaun Vozar Darrell Stern ACHD Epidemiology Kristin Selker Dylan Nagy University of Pittsburgh Evelyn Talbott Judy Rager 38