Marcellus shale development, respiratory & reproductive outcomes in Pennsylvania

项目摘要/摘要 经济发展的历史与能源使用的增长密切相关，主要表现为 化石燃料，以及由此产生的环境和公共健康影响。这些影响中的许多还没有 直到损害发生后的几十年才进行评估。天然气已被宣传为一种清洁能源 以更少的温室气体排放燃烧化石燃料。钻井技术的进展和钻井技术的应用 水力压裂技术可以开采深层页岩中的天然气。许多美国页岩区都有 在过去的十年里得到了积极的发展。因此，人们对环境和健康的担忧 关于地表水、地下水、土壤污染和空气污染的表达。速度、震级和 这些活动的规模推动了现在的健康研究，但几乎没有采取任何措施来解决页岩问题 发展和健康。通过研究与油井活动地点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的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，在 医疗创新。它在一个拥有超过400,000名患者的初级市场为其提供初级保健服务 宾夕法尼亚州中部和东北部的35个县。自2001年以来，它已经有了电子健康记录(EHR)， 允许访问关于临床接触的纵向数据和丰富而详细的健康信息。它的主要特征 市场与宾夕法尼亚州的马塞卢斯地区重叠。我们将建立在两国多年合作经验的基础上 Geisinger和Johns Hopkins使用电子病历数据、临床结果测量、地理信息系统 (地理信息系统)，并使用二级数据来源进行环境评估，以检查怀孕和 与马塞卢斯页岩开发有关的哮喘结果。而孤立的因果联系将 需要更详细的研究，我们才能进行高效和全面的评估 潜在的途径与不利的健康后果有关。我们将研究大约30,000个盖辛格 2006-13年研究期间，接受盖辛格产前护理的哮喘患者和2.2万名母亲出生的婴儿， 靠近和远离页岩开发区，在钻探前、期间和期间发生的事件 油井开发，以及在天然气生产期间。我们将对患者地址进行地理编码；使用地理信息系统和Well 竣工和基础设施数据，以得出住所的暴露指数；然后确定 暴露是否与怀孕和哮喘结局有关。这项拟议的研究借鉴了 关于良好发展和健康的现有数据，是指导更有重点的具体研究的逻辑起点 污染物的路径。通过评估与油井时间和空间方面相关的健康结果 在发展过程中，所有导致人类暴露的许多候选制剂和途径都被纳入。 这样的研究可以为未来的研究提供关键信息，指导政策制定者，最终帮助 以保护该地区人民的健康。

Project Summary/Abstract 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.