Coal processing plant closure tied to drop in heart-related emergency department visits
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Key takeaways:
- The closure of a coal plant in Pittsburgh was tied to a drop in air pollution and a decrease in emergency department admissions for CV causes.
- There was a downward trend for overall ED visits after the closure.
A reduction in air pollution that followed the closure of a coal-coking plant in Pittsburgh was associated with a sharp decline in ED visits for CV-related causes in short- and long-term analyses, researchers reported.
The Shenango Inc. coal-coking plant, located in Allegheny County in Pittsburgh, was closed in January 2016. To assess any CV health benefits that were related to the closure, researchers evaluated site-specific changes in air quality and CV health effects during the 3 years before and 3 years after the plant shutdown, from 2013 to 2018. The researchers compared data from the exposure site, a positive control site (a site adjacent to a still-operating coke plant), and an area in the same state with comparable population density as the exposed site, but without any coking operations nearby.
“They shut the plant and hospital admissions dropped off the shelf,” George Thurston, ScD, a professor in the departments of medicine and population health at NYU Langone, told Healio. “And then, ED admissions continued to decrease over time, as opposed to the prior trend, which was slowly upward before [the closure]. We also looked at a positive control site, where they did not close, and another location with no coking operation. There were no trends like that at those locations.”
Thurston and Wuyue Yu, a doctoral science student at NYU Langone Health, applied an interrupted time series (ITS) model to test the hypothesis that the substantial reduction in air pollution induced by the closure of the plant was followed by immediate and/or longer-term cumulative local CV health benefits.
“As one of the strongest quasi-experimental designs to allow the discernment of health impacts in such situations like dramatic air pollution emission changes, the ITS analysis has become increasingly frequently used for health outcome evaluations of exposures and public health interventions,” Thurston and Yu wrote in Environmental Research: Health. “This study therefore applies statistically rigorous ITS models to test our hypothesis that the substantial reduction in local air pollution induced by the closure of the Shenango Inc. coke plant was accompanied by immediate and/or longer-term declines in cardiovascular disease hospitalizations and emergency department visits.”
After the closure of the plant, researchers observed a 90% decrease in nearby sulfur dioxide levels, as well as significant reductions in coal-related fine particulate matter constituents like sulfate and arsenic.
Using an ITS model, researchers saw a 42% immediate drop (95% CI, 33-51) in CV-related ED visits from the pre-closure mean. The researchers also noted a “longer-term downward trend” for overall emergency visits at –0.14 visits per week rate of decrease after the closure (95% CI, –0.17 to –0.11), compared with an increase of 0.17 visits per week before the closure (95% CI, 0.14-0.2).
Similarly, inpatient CV hospitalizations per year fell after the plant closure by a mean of –27.97 cases per year (95% CI, –46.9 to –9.04) vs. a mean 5.09 increase in cases per year during the prior 3 years (95% CI, –13.84 to 24.02).
“These numbers are much bigger than you would expect based on the studies out here,” Thurston said during an interview. “The EPA monitors and regulates particles by how much they weigh ... but the agency does not consider what kind of particles they are. These particles and their co-pollutants are far more toxic than EPA gives them credit for. That is the main message. Not all particles are the same, and these particles, from fossil fuels, are among the most toxic.”
Thurston said he and colleagues are conducting follow-up research to look for the potential health benefits that may be associated with cleanup measures at another local plant.
“Most of the deaths associated with air pollution are not respiratory,” Thurston told Healio. “They are cardiovascular. Fossil fuel particles have constituents that are very proficient at causing oxidative stress — including transition metals and sulfur. It makes them much more bioavailable, so they can go readily into the bloodstream, systemically. As a society, we have been underestimating the human health benefits of lowering fossil fuel emissions.”
For more information:
George Thurston, ScD, can be reached at george.thurston@nyu.edu.
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