McAlexander Tara P, Bandeen-Roche Karen, Buckley Jessie P, Pollak Jonathan, Michos Erin D, McEvoy John William, Schwartz Brian S
Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA.
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Am Coll Cardiol. 2020 Dec 15;76(24):2862-2874. doi: 10.1016/j.jacc.2020.10.023.
Growing literature linking unconventional natural gas development (UNGD) to adverse health has implicated air pollution and stress pathways. Persons with heart failure (HF) are susceptible to these stressors.
This study sought to evaluate associations between UNGD activity and hospitalization among HF patients, stratified by both ejection fraction (EF) status (reduced [HFrEF], preserved [HFpEF], not classifiable) and HF severity.
We evaluated the odds of hospitalization among patients with HF seen at Geisinger from 2008 to 2015 using electronic health records. We assigned metrics of UNGD activity by phase (pad preparation, drilling, stimulation, and production) 30 days before hospitalization or a frequency-matched control selection date. We assigned phenotype status using a validated algorithm.
We identified 9,054 patients with HF with 5,839 hospitalizations (mean age 71.1 ± 12.7 years; 47.7% female). Comparing 4th to 1st quartiles, adjusted odds ratios (95% confidence interval) for hospitalization were 1.70 (1.35 to 2.13), 0.97 (0.75 to 1.27), 1.80 (1.35 to 2.40), and 1.62 (1.07 to 2.45) for pad preparation, drilling, stimulation, and production metrics, respectively. We did not find effect modification by HFrEF or HFpEF status. Associations of most UNGD metrics with hospitalization were stronger among those with more severe HF at baseline.
Three of 4 phases of UNGD activity were associated with hospitalization for HF in a large sample of patients with HF in an area of active UNGD, with similar findings by HFrEF versus HFpEF status. Older patients with HF seem particularly vulnerable to adverse health impacts from UNGD activity.
越来越多的文献将非常规天然气开发（UNGD）与不良健康状况联系起来，涉及空气污染和应激途径。心力衰竭（HF）患者易受这些应激源的影响。
本研究旨在评估UNGD活动与HF患者住院之间的关联，并按射血分数（EF）状态（降低[HFrEF]、保留[HFpEF]、不可分类）和HF严重程度进行分层。
我们使用电子健康记录评估了2008年至2015年在盖辛格医疗中心就诊的HF患者的住院几率。我们在住院前30天或频率匹配的对照选择日期，按阶段（垫准备阶段钻阶段、增产措施阶段和生产阶段）为UNGD活动分配指标。我们使用经过验证的算法确定表型状态。
我们确定了9054例HF患者，其中5839例住院（平均年龄71.1±12.7岁；47.7%为女性）。将第4四分位数与第1四分位数进行比较，垫准备阶段、钻阶段、增产措施阶段和生产阶段指标对应的住院调整比值比（95%置信区间）分别为1.70（1.35至2.13）、0.97（0.75至1.27）、1.80（1.35至2.40）和1.62（1.07至2.45）。我们未发现HFrEF或HFpEF状态对结果产生效应修饰作用。在基线HF更严重的患者中，大多数UNGD指标与住院的关联更强。
在UNGD活跃地区的大量HF患者样本中，UNGD活动的4个阶段中有3个与HF住院相关，HFrEF与HFpEF状态的结果相似。老年HF患者似乎尤其容易受到UNGD活动对健康的不利影响。
