Marcellus shale development, respiratory & reproductive outcomes in Pennsylvania

描述（由申请人提供）：经济发展的历史与能源（主要以化石燃料的形式）使用的增长密切相关，并由此对环境和公共健康产生影响。其中许多影响直到破坏发生几十年后才被评估出来。天然气作为一种燃烧更清洁、温室气体排放量更少的化石燃料得到了推广。钻井技术的进步和水力压裂技术的使用使得在页岩深处开采天然气成为可能。在过去十年中，美国许多页岩地区都得到了积极开发。因此，人们对地表水、地下水、土壤污染和空气污染等方面的环境和健康问题表示关切。这些活动的速度、规模和规模激发了现在的健康研究，但几乎没有采取任何措施来解决页岩开发和健康问题。通过检查与井活动位置和时间相关的健康模式，我们可以开始确定是否存在与该行业任何方面相关的可识别的健康影响。盖辛格健康系统是一家大型综合医疗保健提供者和健康计划，是医疗保健创新的领导者。它为宾夕法尼亚州中部和东北部超过35个县的初级市场的40多万名患者提供初级保健服务。自2001年以来，它已经有了电子健康记录（EHR），允许访问具有丰富和详细健康信息的临床接触的纵向数据。它的主要市场与宾夕法尼亚州的马塞勒斯地区重叠。我们将利用Geisinger和Johns Hopkins多年来在使用电子病历数据、临床结果测量、地理信息系统（GIS）和使用二手数据源进行环境评估方面的联合经验，研究与Marcellus页岩开发有关的妊娠和哮喘结果。虽然分离因果关系需要更详细的研究，但我们可以对任何潜在途径是否与不良健康结果有关进行有效和全面的评估。在2006- 2013年的研究期间，我们将研究大约30,000名Geisinger哮喘患者和22,000名在Geisinger产前护理下分娩的母亲，这些母亲离页岩开发区域近或远，在钻井前、井开发期间和天然气生产期间发生的事件。我们将对病人的地址进行地理编码；利用GIS、完井和基础设施数据推导出家庭住宅的暴露指数；然后确定暴露是否与怀孕和哮喘有关。拟议的研究利用了现有的油井开发和健康数据，这是一个合理的起点，可以指导对特定污染物途径进行更有针对性的研究。通过评估与油井开发的时间和空间方面相关的健康结果，将导致人类接触的所有许多候选物剂和途径纳入其中。这样的研究可以为今后的研究提供关键信息，指导决策者，并最终有助于保护该地区人口的健康。

DESCRIPTION (provided by applicant): The history of economic development is intimately linked to growth in the use of energy, largely in the form of fossil fuels, with resultant environmental and public health impacts. Many of these impacts have not been evaluated until decades after the damage has been done. Natural gas has been promoted as a cleaner burning fossil fuel with less greenhouse gas emissions. Advances in drilling technologies and the use of hydraulic fracturing allow the exploitation of natural gas in deep deposits of shale. Many US shale regions have been aggressively developed in the last decade. As a result, environmental and health concerns have been expressed regarding surface water, ground water, soil pollution, and air pollution. The speed, magnitude and scale of these activities motivate health studies now, yet almost nothing has been done to address shale development and health. By examining health patterns in relation to location and timing of well activities, we can begin to determine whether there are identifiable health effects associated with any aspect of the industry. The Geisinger Health System is a large integrated health care provider and health plan that is a leader in health care innovation. It provides primary care services to over 400,000 patients in a primary market of over 35 counties in central and northeastern Pennsylvania. It has had an electronic health record (EHR) since 2001, allowing access to longitudinal data on clinical encounters with rich and detailed health information. Its primary market overlaps with the Marcellus region in Pennsylvania. We will build on years of joint experience between Geisinger and Johns Hopkins in using EHR data, clinical outcome measures, geographic information systems (GIS), and the use of secondary data sources for environmental assessment, to examine pregnancy and asthma outcomes in relation to Marcellus shale development. While isolating cause and effect linkages would require more detailed study, we can conduct an efficient and comprehensive evaluation of whether any potential pathways are related to adverse health outcomes. We will study approximately 30,000 Geisinger asthma patients and 22,000 births to mothers with Geisinger prenatal care during the study period 2006-13, proximal to and distant from areas of shale development, with events across the period prior to drilling, during well development, and during natural gas production. We will geocode patient addresses; use GIS and well completion and infrastructure data to derive indices of exposure at the home residence; and then determine whether exposure is associated with pregnancy and asthma outcomes. The proposed research draws on existing data on well development and health, a logical starting point to guide more focused studies of specific pollutant pathways. By evaluating health outcomes in relation to temporal and spatial aspects of well development, all of the many candidate agents and pathways resulting in human exposure are incorporated. Such a study can provide critical information to focus future research, guide policy makers, and ultimately help to protect the health of populations in the region.