Environment/Climate Change
The rise of unconventional natural gas development and the fall of coal-fired power plants: Associations with pediatric asthma onset in Pennsylvania Nina M. Flores* Nina Flores Gabriella Meltzer Heather McBrien Kara E. Rudolph Lucas RF Henneman Xin Fang Dione Mercer Jordan Law Brian S. Schwartz Stephanie Lovinsky-Desir Mary Willis Joan A. Casey
As a result of regulation, lower prices, and technological advances, in 2015, natural gas surpassed coal as the primary US electricity source. During the transition from coal to natural gas, many children lived in communities dually exposed to coal-fired power plants and unconventional natural gas development (UNGD). Although previous analyses have identified associations between exposure to coal-fired power plants or UNGD and asthma exacerbation, none have considered relations with incident asthma, these fossil fuel exposures in tandem, or the role of individual-level socioeconomic status.
We used 2006-2020 electronic health record data from Geisinger in Pennsylvania and longitudinal modified treatment policy methodology to estimate asthma incidence under hypothetical coal or UNGD interventions. Each hypothetical intervention reduced exposures during the first 3 years of life for those with exposure above the 75th percentile to the 75th percentile. Models adjusted for date of birth and sex, Medical Assistance, race/ethnicity, maternal age, household tobacco smoke, residential latitude/longitude, county-level population density and community socioeconomic deprivation, annual average nitrogen dioxide concentration, and seasonal greenspace. We examined whether the use of Medical Assistance modifies these relationships.
Among 10,808 children, the estimated asthma incidence at age 12 under no intervention on coal exposure was 11 per 100 (95% CI 11-12); under the hypothetical intervention incidence was 9 per 100 (7-10). The estimated asthma incidence at age 12 under no UNGD intervention was 10 per 100 (9-11), and 9 per 100 (8-11) with the hypothetical intervention. We show estimated incidences from year 7-13 in Figure 1 overall (top) and among Medical Assistance users (bottom).
Intervention to reduce coal and UNGD exposures could reduce asthma incidence, especially among low-income individuals, who are disproportionately burdened by adverse health effects of such exposures.
