Toolkit―Respiratory & Cardiovascular
In 2021, the State of the Air report, published annually by the American Lung Association, reported that 40% of Americans, or four in ten people, live in areas with unhealthy air pollution levels. This report considers the most widespread air pollutants, including fine particulate matter, ozone, and volatile organic compounds. All these air pollutants are emitted during the various stages of shale gas development (SGD).
These pollutants are known to trigger or worsen a variety of respiratory and cardiovascular diseases, including asthma, chronic obstructive pulmonary disease (COPD), cerebrovascular accidents (stroke), acute coronary syndrome, and many others. Heart disease is already the leading cause of death in the United States, and air pollution only contributes more to this problem. The American Heart Association advocates for measures that reduce exposure to air pollution and recommends that physicians and other health professionals talk to their patients about the cardiovascular and respiratory disease risks from exposure to polluted air.
Infographic courtesy of Dr. Lal PathLabs Limited (2018).
WHAT THE RESEARCH SAYS
Denham, A., Willis, M. D., Croft, D., et al. (2021): Acute Myocardial Infarction (Heart Attack) Associated With Unconventional Natural Gas Development: A Natural Experiment.
Researchers in this study examined hospital discharge and mortality data related to acute myocardial infarction (AMI) from 2005-2014 from people living in Pennsylvania (where shale gas activity is high) and New York (where shale gas drilling is banned). They found:
Hospitalization rates for heart attacks increased in PA counties that hosted shale gas drilling when compared with NY communities that did not.
The increase was seen in males between 45-54 years old and men and women 65 and older.
Mortality from AMI was more than 5% higher in middle-aged males in PA when compared to NY communities.
McAlexander, T. P., Bandeen-Roche, K., Buckley, J. P., et al. (2020): Unconventional Natural Gas Development and Hospitalization for Heart Failure in Pennsylvania.
Researchers in this study examined associations between SGD and hospitalization rates with heart failure (HF) patients from 2008-2015 using electronic health records from Geisinger. They found:
Over 9,000 HF patients with over 5,000 hospitalizations. The average age was 71, and 47% were females.
SGD activity was examined in four phases: pad preparation, drilling, stimulation, and production. The adjusted odds ratios for HF with the four phases were 1.70, 0.97, 1.80, and 1.62 respectively.
Older patients with HF were particularly vulnerable to adverse health outcomes from SGD.
Croft, D. P., Zhang, W., Lin, S., et al. (2019). The Association between Respiratory Infection and Air Pollution in the Setting of Air Quality Policy and Economic Change.
This study examined the rate of respiratory infections in adults in association with increases in fine particulate matter 2.5 (PM2.5 ) concentrations, specifically in the New York region. The researchers found:
Over 400,000 adults in NY had a primary diagnosis of influenza, bacterial pneumonia, or culture-negative pneumonia from hospital or ER visits between 2005-2016.
Researchers estimated the rate of healthcare encounters associated with increases in PM2.5 within the last 1-7 days and then looked at the differences between 2005-2007, 2008-2013, and 2014-2016.
Increased rates of culture-negative pneumonia and influenza were associated with increases in PM2.5 during the week prior.
This association continued despite changes in air quality policies or economic changes.
Willis, M. D., Jusko, T. A., Halterman, J. S., et al. (2018). Unconventional natural gas development and pediatric asthma hospitalizations in Pennsylvania.
This study set out to quantify the association between SGD and pediatric asthma hospitalizations. The researchers compared pediatric asthma hospitalizations by zip code with those exposed to SGD and those not exposed between 2003-2014. They found:
Elevated odds of hospitalization were consistently observed in those in closer proximity to SGD.
During the time when the well was drilled, there was a 25% increase in the odds of being hospitalized for asthma.
Rasmussen, S. G., Ogburn, E. L., McCormack, M., et al., (2016). Asthma Exacerbations and Unconventional Natural Gas Development in the Marcellus Shale.
This study evaluated the association between SGD and asthma exacerbations in Pennsylvania. Asthma patients with exacerbations between 2005-2012 were compared with those without exacerbations. The researchers found:
SGD activity was statistically associated with increased odds of mild, moderate, and severe asthma exacerbations.
Health and Environmental Effects of Particulate Matter (PM), Environmental Protection Agency (EPA)
Fracking Fumes - Air Pollution Impacts on Health and Well-Being, Rutgers Robert Wood Johnson Medical School, EOHSI, Center for Environmental Exposures and Disease
Croft, D. P., Zhang, W., Lin, S., Thurston, S. W., Hopke, P. K., Masiol, M., Squizzato, S., van
Wijngaarden, E., Utell, M. J., & Rich, D. Q. (2018). The Association between Respiratory Infection and Air Pollution in the Setting of Air Quality Policy and Economic Change. Annals of the American Thoracic Society. https://doi.org/10.1513/annalsats.201810-691oc
Denham, A., Willis, M. D., Croft, D. P., Liu, L., & Hill, E. L. (2021). Acute myocardial infarction associated with unconventional natural gas development: A natural experiment. Environmental Research, 195, 110872. https://doi.org/10.1016/j.envres.2021.110872
McAlexander, T. P., Bandeen-Roche, K., Buckley, J. P., Pollak, J., Michos, E. D., McEvoy, J. W., &
Schwartz, B. S. (2020). Unconventional Natural Gas Development and Hospitalization for Heart Failure
in Pennsylvania. Journal of the American College of Cardiology, 76(24), 2862–2874.
Rasmussen, S. G., Ogburn, E. L., McCormack, M., Casey, J. A., Bandeen-Roche, K., Mercer, D. G., &
Schwartz, B. S. (2016). Association Between Unconventional Natural Gas Development in the Marcellus
Shale and Asthma Exacerbations. JAMA Internal Medicine, 176(9), 1334.
Willis, M. D., Jusko, T. A., Halterman, J. S., & Hill, E. L. (2018). Unconventional natural gas
development and pediatric asthma hospitalizations in Pennsylvania. Environmental Research,
166, 402–408. https://doi.org/10.1016/j.envres.2018.06.022