Coal-fired power plants release substantial air pollution, which included over 60% of US sulfur dioxide emissions in 2014. Such air pollution may exacerbate asthma, but direct studies of the health impacts linked to power plant air pollution are rare. Here we take advantage of a natural experiment in Louisville, Kentucky, where one coal-fired power plant was retired and converted to natural gas, and three others installed SO2 emission control systems between 2013 and 2016. Dispersion modelling indicated that exposure to SO2 emissions from these power plants decreased after the energy transitions. We used several analysis strategies, which include difference-in-differences, first-difference and interrupted time-series modelling to show that the emissions control installations and plant retirements are associated with a reduced asthma disease burden related to hospitalizations and emergency room visits at the ZIP-code level, and to individual-level medication use as measured by digital medication sensors.
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The ZIP-code-level asthma hospitalization and ERV data are available from the authors following the submission of an analysis proposal and written approval granted by the Louisville Metro Public Health and Wellness. The AIR Louisville monthly medication use data are considered Protected Health Information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in the United States, and as such may be accessible from the authors for analysis only after specific written authorization of access following HIPAA guidelines and Institutional Review Board approval. We provide Jefferson County ZIP-code-level monthly HyADS estimates on GitHub at https://github.com/joanacasey/ky_asthma_coal.
IEA Statistics (International Energy Agency, 2018); http://www.iea.org/statistics/
Massetti, E. et al. Environmental Quality and the US Power Sector: Air Quality, Water Quality, Land Use and Environmental Justice (Oak Ridge National Laboratory, 2017); https://www.energy.gov/sites/prod/files/2017/01/f34/Environment%20Baseline%20Vol.%202–Environmental%20Quality%20and%20the%20U.S.%20Power%20Sector–Air%20Quality%2C%20Water%20Quality%2C%20Land%20Use%2C%20and%20Environmental%20Justice.pdf
Toxic Air: The Case for Cleaning Up Coal-Fired Power Plants (American Lung Association, 2011); http://www.lung.org/assets/documents/healthy-air/toxic-air-report.pdf
Zheng, X.-Y et al. Association between air pollutants and asthma emergency room visits and hospital admissions in time series studies: a systematic review and meta-analysis. PLoS ONE 10, e0138146 (2015).
Orellano, P., Quaranta, N., Reynoso, J., Balbi, B. & Vasquez, J. Effect of outdoor air pollution on asthma exacerbations in children and adults: systematic review and multilevel meta-analysis. PLoS ONE 12, e0174050 (2017).
Williams, A. M., Phaneuf, D. J., Barrett, M. A. & Su, J. G. Short-term impact of PM2.5 on contemporaneous asthma medication use: behavior and the value of pollution reductions. Proc. Natl Acad. Sci. USA 116, 5246–5253 (2019).
Integrated Science Assessment for Oxides of Nitrogen-Health Criteria (US Environmental Protection Agency, 2016); http://ofmpub.epa.gov/eims/eimscomm.getfile?p_download_id=526855
Integrated Review Plan for the Primary National Ambient Air Quality Standard for Sulfur Dioxide EPA-452/R-14-007 (US Environmental Protection Agency, 2014); https://www3.epa.gov/ttn/naaqs/standards/so2/data/20141028so2reviewplan.pdf
Ramadour, M. et al. Prevalence of asthma and rhinitis in relation to long-term exposure to gaseous air pollutants. Allergy 55, 1163–1169 (2000).
Guarnieri, M. & Balmes, J. R. Outdoor air pollution and asthma. Lancet 383, 1581–1592 (2014).
Deger, L. et al. Active and uncontrolled asthma among children exposed to air stack emissions of sulphur dioxide from petroleum refineries in Montreal, Quebec: a cross-sectional study. Can. Respir. J. 19, 97–102 (2012).
Charpin, D. et al. Respiratory symptoms and air pollution changes in children: the Gardanne Coal-Basin Study. Arch. Environ. Health 43, 22–27 (1988).
Schenker, M. B., Speizer, F. E., Samet, J. M., Gruhl, J. & Batterman, S. Health effects of air pollution due to coal combustion in the Chestnut Ridge Region of Pennsylvania: results of cross-sectional analysis in adults. Arch. Environ. Health 38, 325–330 (1983).
Dubnov, J. et al. Estimating the effect of air pollution from a coal-fired power station on the development of children’s pulmonary function. Environ. Res. 103, 87–98 (2007).
Cohen, A. A., Bromberg, S., Buechley, R. W., Heiderscheit, L. T. & Shy, C. M. Asthma and air pollution from a coal-fueled power plant. Am. J. Public Health 62, 1181–1188 (1972).
Smargiassi, A. et al. Risk of asthmatic episodes in children exposed to sulfur dioxide stack emissions from a refinery point source in Montreal, Canada. Environ. Health Perspect. 117, 653 (2009).
Rodriguez-Villamizar, L. A., Rosychuk, R. J., Osornio-Vargas, A., Villeneuve, P. J. & Rowe, B. H. Proximity to two main sources of industrial outdoor air pollution and emergency department visits for childhood asthma in Edmonton, Canada. Can. J. Public Health 108, e523–e529 (2017).
Middleton, N., Kolokotroni, O., Lamnisos, D., Koutrakis, P. & Yiallouros, P. K. Prevalence of asthma and respiratory symptoms in 15–17-year-old Greek-Cypriots by proximity of their community of residence to power plants: Cyprus 2006–07. Public Health 128, 288–296 (2014).
Liu, X., Lessner, L. & Carpenter, D. O. Association between residential proximity to fuel-fired power plants and hospitalization rate for respiratory diseases. Environ. Health Perspect. 120, 807–810 (2012).
Form EIA-860 (US Energy Information Administration, 2019); https://www.eia.gov/electricity/data/eia860/
Humphreys, D. K., Panter, J., Sahlqvist, S., Goodman, A. & Ogilvie, D. Changing the environment to improve population health: a framework for considering exposure in natural experimental studies. J. Epidemiol. Community Health 70, 941–946 (2016).
Rich, D. Q. Accountability studies of air pollution and health effects: lessons learned and recommendations for future natural experiment opportunities. Environ. Int. 100, 62–78 (2017).
Zigler, C. M. & Dominici, F. Point: clarifying policy evidence with potential-outcomes thinking—beyond exposure–response estimation in air pollution epidemiology. Am. J. Epidemiol. 180, 1133–1140 (2014).
Pope, C. A. 3rd Respiratory disease associated with community air pollution and a steel mill, Utah Valley. Am. J. Public Health 79, 623–628 (1989).
Clancy, L., Goodman, P., Sinclair, H. & Dockery, D. W. Effect of air-pollution control on death rates in Dublin, Ireland: an intervention study. Lancet 360, 1210–1214 (2002).
Friedman, M. S., Powell, K. E., Hutwagner, L., Graham, L. M. & Teague, W. G. Impact of changes in transportation and commuting behaviors during the 1996 Summer Olympic Games in Atlanta on air quality and childhood asthma. J. Am. Med. Assoc. 285, 897–905 (2001).
Li, Y., Wang, W., Kan, H., Xu, X. & Chen, B. Air quality and outpatient visits for asthma in adults during the 2008 Summer Olympic Games in Beijing. Sci. Total. Environ. 408, 1226–1227 (2010).
Deschenes, O., Greenstone, M. & Shapiro, J. S. Defensive investments and the demand for air quality: evidence from the NOx budget program. Am. Econ. Rev. 107, 2958–2989 (2017).
National Emissions Inventory (US Environmental Protection Agency, 2011); https://www.epa.gov/air-emissions-inventories/2011-national-emissions-inventory-nei-data
Henneman, L. R. F., Choirat, C., Ivey, C. E., Cummiskey, K. & Zigler, C. M. Characterizing population exposure to coal emissions sources in the United States using the HyADS model. Atmos. Environ. 203, 271–280 (2019).
Henneman, L. R. F., Mickley, L. J. & Zigler, C. M. Air pollution accountability of energy transitions: the relative importance of wind fields and emissions in exposure changes. Environ. Res. Lett. 14, 115003 (2019).
Zein, J. G. et al. Impact of age and sex on outcomes and hospital cost of acute asthma in the United States, 2011-2012. PLoS ONE 11, e0157301 (2016).
Patel, M. et al. Metrics of salbutamol use as predictors of future adverse outcomes in asthma. Clin. Exp. Allergy 43, 1144–1151 (2013).
Prieto-Parra, L. et al. Air pollution, PM2.5 composition, source factors, and respiratory symptoms in asthmatic and nonasthmatic children in Santiago, Chile. Environ. Int 101, 190–200 (2017).
Schildcrout, J. S. et al. Ambient air pollution and asthma exacerbations in children: an eight-city analysis. Am. J. Epidemiol. 164, 505–517 (2006).
U.S. Environmental Protection Agency. Federal Registrar. Primary National Ambient Air Quality Standard for Sulfur Dioxide, Final Rule, 40 CFR Parts 50, 53, and 58., <https://www.govinfo.gov/content/pkg/FR-2010-06-22/pdf/2010-13947.pdf> (2010).
Gowers, A. M. et al. Does outdoor air pollution induce new cases of asthma? Biological plausibility and evidence; a review. Respirology 17, 887–898 (2012).
Johns, D. O. & Linn, W. S. A review of controlled human SO2 exposure studies contributing to the US EPA integrated science assessment for sulfur oxides. Inhal. Toxicol. 23, 33–43 (2011).
Li, R. et al. Effect of sulfur dioxide on inflammatory and immune regulation in asthmatic rats. Chemosphere 112, 296–304 (2014).
Amster, E. D., Haim, M., Dubnov, J. & Broday, D. M. Contribution of nitrogen oxide and sulfur dioxide exposure from power plant emissions on respiratory symptom and disease prevalence. Envrion. Pollut. 186, 20–28 (2014).
Anenberg, S. C. et al. Estimates of the global burden of ambient PM2.5, ozone, and NO2 on asthma incidence and emergency room visits. Environ. Health Perspect. 126, 107004 (2018).
Achakulwisut, P., Brauer, M., Hystad, P. & Anenberg, S. C. Global, national, and urban burdens of paediatric asthma incidence attributable to ambient NO2 pollution: estimates from global datasets. Lancet Planet Health 3, e166–e178 (2019).
Dominici, F., Greenstone, M. & Sunstein, C. R. Particulate matter matters. Science 344, 257–259 (2014).
Cushing, L., Morello-Frosch, R., Wander, M. & Pastor, M. The haves, the have-nots, and the health of everyone: the relationship between social inequality and environmental quality. Annu. Rev. Public Health 36, 193–209 (2015).
Baltrus, P. et al. Individual and county level predictors of asthma related emergency department visits among children on Medicaid: a multilevel approach. J. Asthma 54, 53–61 (2017).
Craig, P., Katikireddi, S. V., Leyland, A. & Popham, F. Natural experiments: an overview of methods, approaches, and contributions to public health intervention research. Annu. Rev. Public Health 38, 39–56 (2017).
Barrett, M. et al. AIR Louisville: addressing asthma with technology, crowdsourcing, cross-sector collaboration, and policy. Health Affairs 37, 525–534 (2018).
Anderson, H. R., Favarato, G. & Atkinson, R. W. Long-term exposure to outdoor air pollution and the prevalence of asthma: meta-analysis of multi-community prevalence studies. Air Qual. Atmos. Health 6, 57–68 (2013).
2016 National Health Interview Survey (NHIS) Data (US Centers for Disease Control & Prevention, 2016); https://www.cdc.gov/asthma/nhis/2016/table3-1.htm
Air Markets Program Data (US Environmental Protection Agency, 2018); https://ampd.epa.gov/ampd/
Stein, A. et al. NOAA’s HYSPLIT atmospheric transport and dispersion modeling system. Bull. Am. Meteorol. Soc. 96, 2059–2077 (2015).
Henneman, L. R. F., Dedoussi, I. C., Casey, J. A., Choirat, C. & Zigler, C. M. Comparisons of simple and complex methods for quantifying exposure to point source air pollution emissions. J. Expo. Sci. Environ. Epidemiol. https://doi.org/10.1038/s41370-020-0219-1 (2020).
Henneman, L. R. F., Choirat, C. & Zigler, C. M. Accountability assessment of health improvements in the United States associated with reduced coal emissions between 2005 and 2012. Epidemiology 30, 477–485 (2019).
Mill Creek Station Wins 2016 Project of the Year Award (Louisville Gas & Electric, 2017); https://lge-ku.com/newsroom/articles/2017/01/09/mill-creek-station-wins-2016-project-year-award
Manson, S., Schroeder, J., Riper, D. V. & Ruggles, S. IPUMS National Historical Geographic Information System: Version 13.0 (IPUMS, 2018); https://doi.org/10.18128/D050.V12.0
Gottlieb, D. J., Beiser, A. S. & O’Connor, G. T. Poverty, race, and medication use are correlates of asthma hospitalization rates: a small area analysis in Boston. Chest 108, 28–35 (1995).
Air Data Pre-generated Data Files (US Environmental Protection Agency) https://aqs.epa.gov/aqsweb/airdata/download_files.html
Merchant, R. K., Inamdar, R. & Quade, R. C. Effectiveness of population health management using the propeller health asthma platform: a randomized clinical trial. J. Allergy Clin. Immunol. Pract. 4, 455–463 (2016).
Van Sickle, D., Magzamen, S., Truelove, S. & Morrison, T. Remote monitoring of inhaled bronchodilator use and weekly feedback about asthma management: an open-group, short-term pilot study of the impact on asthma control. PLoS ONE 8, e55335 (2013).
National Centers for Environmental Information, Weather and Climate Data (National Oceanic and Atmospheric Administration, accessed 13 February 2017); https://www.ncdc.noaa.gov/orders/qclcd/
CDC’s Social Vulnerability Index (SVI) (US Centers for Disease Control & Prevention, 2016); https://svi.cdc.gov/data-and-tools-download.html
Angrist, J. D. & Pischke, J.-S. Mostly Harmless Econometrics: An Empiricist’s Companion (Princeton Univ. Press, 2009).
Glymour, M. & Greenland, S. in Modern Epidemiology 3rd edn (eds Rothman, K. J., Greenland, S. & Lash, T. L.) 183–209 (Lippincott Williams and Wilkins, 2008).
Pope, C. A. 3rd, Ezzati, M. & Dockery, D. W. Fine-particulate air pollution and life expectancy in the United States. N. Engl. J. Med. 360, 376–386 (2009).
Abadie, A., Athey, S., Imbens, G. W. & Wooldridge, J. When Should You Adjust Standard Errors for Clustering? (NBER, 2017); https://www.nber.org/papers/w24003
Armstrong, B. G., Gasparrini, A. & Tobias, A. Conditional Poisson models: a flexible alternative to conditional logistic case cross-over analysis. BMC Med. Res. Methodol. 14, 122 (2014).
Bernal, J. L., Cummins, S. & Gasparrini, A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int. J. Epidemiol. 46, 348–355 (2017).
Petersen, I., Douglas, I. & Whitaker, H. Self controlled case series methods: an alternative to standard epidemiological study designs. Br. Med. J. 354, i4515 (2016).
Brumback, B. A. et al. Transitional regression models, with application to environmental time series. J. Am. Stat. Assoc. 95, 16–27 (2000).
We acknowledge the network of local partners that made the AIR Louisville program possible, which include the Center for Healthy Air, Water and Soil, Louisville Metro, the Community Foundation of Louisville and all the AIR Louisville participants. Partners within the Louisville Metro Government include G. Fischer, the Office of Civic Innovation, Louisville Metro Department of Public Health and Wellness, the Office of Sustainability, the Office of Advanced Planning, the Louisville Jefferson County Information Consortium and Louisville Forward. Specifically, K. Talley, M. King and R. Hamilton of the Air Pollution Control District provided critical information and review of this manuscript. We also thank P. Tarini and O. Wójcik at the Robert Wood Johnson Foundation for helpful guidance throughout the project. The main funding for the project was provided by the Robert Wood Johnson Foundation. Support was also provided by the Foundation for a Healthy Kentucky, Norton Healthcare Foundation, Owsley Brown Charitable Foundation, the American Lung Association, the National Institute of Environmental Health Sciences (J.A.C., K99/R00 ES027023; A.M.N, K99/R00 ES027511; C.Z., R01 ES026217) and the USEPA (C.Z., EPA 83587201). The contents of this work are solely the responsibility of the grantee and do not necessarily represent the official views of the USEPA or the Robert Wood Johnson Foundation. Further, the USEPA does not endorse the purchase of any commercial products or services mentioned in the publication.
M.A.B., R.G. and L.K. are salaried employees of Propeller Health and J.G.S. receives limited funding from Propeller Health to conduct analyses.
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Casey, J.A., Su, J.G., Henneman, L.R.F. et al. Improved asthma outcomes observed in the vicinity of coal power plant retirement, retrofit and conversion to natural gas. Nat Energy 5, 398–408 (2020). https://doi.org/10.1038/s41560-020-0600-2
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