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Energy and health

Coal-fired power plant closures and retrofits reduce asthma morbidity in the local population

A Publisher Correction to this article was published on 14 May 2020

A Publisher Correction to this article was published on 14 May 2020

This article has been updated

Retiring, transitioning or installing more stringent emissions controls in coal-fired power plants has the potential to decrease asthma attacks and asthma-related emergency department visits and hospitalizations in nearby communities. These health co-benefits should be considered in policy and decision making about coal-fired power plant retirement or retrofit.

Messages for Policy

  • Retiring or converting power plants from coal to natural gas could confer health benefits on people with asthma.

  • In Louisville, Kentucky, coal-fired power plant retirements and SO2 control installations led to reductions in SO2 emissions and air pollution exposure.

  • This reduction in air pollution exposure translated into substantially fewer asthma-related emergency department visits and hospitalizations.

  • Given that 20.4 million adults, or about 9% of the population, suffer from asthma, the shift in US energy trends away from coal-fired electricity generation may reduce asthma morbidity below otherwise expected levels.

  • Digital health tools, such as wirelessly connected inhalers that track the time and date of medication use, can assist in analysing asthma symptoms outside the hospital and in gauging the impact of air pollution exposure on a community. They may serve as supplemental public health research tools in the future.

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Fig. 1: Coal-fired power plant emissions exposures and asthma outcomes in Louisville, KY.

Change history

  • 14 May 2020

    An amendment to this paper has been published and can be accessed via a link at the top of the paper.


Further Reading

  • Barrett, M. et al. AIR Louisville: addressing asthma with technology, crowdsourcing, cross-sector collaboration, and policy. Health Aff. 37, 525–534 (2018). Overview of the AIR Louisville cohort and Propeller’s digital medication sensors.

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  • Guarnieri, M. & Balmes, J. R. Outdoor air pollution and asthma. LAncet 383, 1581–1592 (2014). Review article discussing mechanisms by which air pollution can cause asthma exacerbation.

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  • 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). Technical article on the HyADS model used to estimate coal-fired power plant exposures.

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  • 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). Description of the utility of natural experiments to study air pollution and health outcomes.

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  • 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). Case-crossover study linking modelled daily SO 2 levels to asthma hospitalizations and ER visits in children.

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  • 2016 National Health Interview Survey (NHIS) Data (CDC, accessed 28 February 2019); Report that states 9% prevalence of asthma in the United States.

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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 US Environmental Protection Agency (US EPA) (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 US EPA or the Robert Wood Johnson Foundation. Further, the US EPA does not endorse the purchase of any commercial products or services mentioned in the publication.

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Correspondence to Joan A. Casey.

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Competing interests

The authors declare the following competing interests: 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. Coal-fired power plant closures and retrofits reduce asthma morbidity in the local population. Nat Energy 5, 365–366 (2020).

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