Accountability Assessment of Health Improvements in the United States Associated with Reduced Coal Emissions Between 2005 and 2012
Accountability Assessment of Health Improvements in the United States Associated with Reduced Coal Emissions Between 2005 and 2012
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DOI：
10.1097/ede.0000000000001024
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发表时间：
2019-07-01
期刊：
影响因子：
5.4
通讯作者：
Zigler, Corwin M.
中科院分区：
文献类型：
--
作者：
Henneman, Lucas R. F.;Choirat, Christine;Zigler, Corwin M.
背景：2005年至2012年期间，美国国家、州和地方政策推动燃煤电厂二氧化硫排放量减少65%，这为在空气污染问责制框架下直接量化这些减排所带来的公共卫生效益提供了机会。方法：我们通过两个不同但相关的暴露指标：PM2.5总浓度和对燃煤电厂排放的暴露来估计邮政编码水平的变化。我们将2005年至2012年间约3000万美国医疗保险受益人的10项健康转归率的变化与暴露变化联系起来，采用了两种差分回归方法，旨在减轻观察到的和未观察到的混淆。结果：六种心脏和呼吸系统健康结果——所有心血管疾病、慢性阻塞性肺疾病、心血管中风、心力衰竭、缺血性心脏病和呼吸道感染——每万人年的发病率下降了7.89至1.95,PM2.5每亩立方厘米-3下降了7.89至1.95，而煤暴露的相应下降导致的发病率下降幅度略大。急性心肌梗死、心律失常和周围血管疾病的结果接近于零和/或在各种暴露指标和分析之间混合。另一项分析发现，不断变化的健康转归率与煤炭暴露之间的非线性关系可能解释了它们之间关联的差异。结论：对减排的直接分析估计，燃煤电厂排放和PM2.5浓度的降低对健康有实质性的好处。与两种暴露指标变化相关的不同反应强调了将源特异性影响与PM2.5总暴露造成的影响隔离开来的重要性。
Background: National, state, and local policies contributed to a 65% reduction in sulfur dioxide emissions from coal-fired power plants between 2005 and 2012 in the United States, providing an opportunity to directly quantify public health benefits attributable to these reductions under an air pollution accountability framework.Methods: We estimate ZIP code-level changes in two differentbut related-exposure metrics: total PM2.5 concentrations and exposure to coal-fired power plant emissions. We associate changes in 10 health outcome rates among approximately 30 million US Medicare beneficiaries with exposure changes between 2005 and 2012 using two difference-in-difference regression approaches designed to mitigate observed and unobserved confounding.Results: Rates per 10,000 person-years of six cardiac and respiratory health outcomes-all cardiovascular disease, chronic obstructive pulmonary disorder, cardiovascular stroke, heart failure, ischemic heart disease, and respiratory tract infections-decreased by between 7.89 and 1.95 per mu gm-3 decrease in PM2.5, with comparable decreases in coal exposure leading to slightly larger rate decreases. Results for acute myocardial infarction, heart rhythm disorders, and peripheral vascular disease were near zero and/or mixed between the various exposure metrics and analyses. A secondary analysis found that nonlinearities in relationships between changing health outcome rates and coal exposure may explain differences in their associations.Conclusions: The direct analyses of emissions reductions estimate substantial health benefits via coal power plant emission and PM2.5 concentration reductions. Differing responses associated with changes in the two exposure metrics underscore the importance of isolating source-specific impacts from those due to total PM2.5 exposure.