Marcellus shale development, respiratory & reproductive outcomes in Pennsylvania

描述(申请人提供)：经济发展的历史与能源使用的增长密切相关，主要是以化石燃料的形式，由此产生的环境和公共健康影响。其中许多影响直到损害发生几十年后才进行评估。天然气已被推广为一种更清洁的燃烧化石燃料，温室气体排放更少。钻井技术的进步和水力压裂的使用使页岩深层矿藏中的天然气得以开采。过去10年，美国许多页岩地区都得到了大力开发。因此，人们对地表水、地下水、土壤污染和空气污染表示了环境和健康方面的关切。这些活动的速度、规模和规模推动了现在的健康研究，但几乎没有采取任何行动来解决页岩开发和健康问题。通过检查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商和健康计划，在医疗保健创新方面处于领先地位。它在宾夕法尼亚州中部和东北部的35个县的初级市场为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的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卢斯地区重叠。我们将以盖辛格和约翰霍普金斯公司多年的联合经验为基础，使用EHR数据、临床结果指标、地理信息系统(GIS)以及环境评估的二次数据源来检查与Marcellus页岩开发相关的怀孕和哮喘结果。虽然分离因果关系需要更详细的研究，但我们可以对是否有任何潜在的途径与不利的健康后果有关进行有效和全面的评估。我们将研究2006-13年期间在页岩开发区附近和远离页岩开发区的大约30,000名盖辛格哮喘患者和22,000名母亲在盖辛格产前护理下的分娩，以及钻探前、油井开发期间和天然气生产期间的事件。我们将对患者地址进行地理编码；使用地理信息系统以及完井和基础设施数据来得出家庭住所的暴露指数；然后确定暴露是否与怀孕和哮喘结局有关。拟议的研究利用了关于油井发展和健康的现有数据，这是一个合理的起点，可以指导对特定污染物路径的更有重点的研究。通过评估与油井开发的时间和空间方面有关的健康结果，所有导致人类暴露的候选因素和途径都被纳入其中。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，并最终帮助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.