Complete study: Unconventional Natural Gas Development and Hospitalization for Heart Failure in Pennsylvania by Tara P. McAlexander , Karen Bandeen-Roche , Jessie P. Buckley , Jonathan Pollak , Erin D. Michos , John William McEvoy , and Brian S. Schwartz, J Am Coll Cardiol, 2020 Dec, 76 (24) 2862–2874
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.
Unconventional Natural Gas Development and Heart Failure: Accumulating Epidemiological Evidence Editorial Comment by Barrak Alahmad and Haitham Khraishah, J Am Coll Cardiol, 2020 Dec, 76 (24) 2875–2877
… Various stressors are implicated in the different stages of UNGD; these include:
1) environmental exposures including, but not limited to, particulate and gaseous air pollutants and water quality (1–3);
2) psychosocial exposures such as stress from noise and traffic (4); and
The rapid UNGD booming around the world and in the United States was outpacing environmental health studies on affected local communities. Although the initial reports of adverse health impacts of UNGD mainly examined perinatal outcomes and respiratory effects (1), more emerging studies are now examining a variety of health outcomes, including cardiovascular diseases.
Around the world, heart failure is a global health crisis affecting at least 26 million people (6). Heart failure is also expensive to treat. Despite advances in medical management, heart failure is characterized by recurrent hospitalizations that are inevitable (7). In the United States, more than $31 billion were spent on heart failure in 2012, and the expected cost in the future could increase by 127% by 2030 (8).
In this issue of the Journal, McAlexander et al. (9) used electronic health records to obtain data consisting of >9,000 heart failure patients who could be at risk of UNGD exposure across Pennsylvania. To the best of our knowledge, this comprehensive case-control analysis is the first epidemiological investigation regarding the impacts of UNGD on heart failure outcomes. The exposure metric, which captures not only distance to wells but also the number of wells, their depth, and stages of production, has been used in previous papers, most notably by Casey et al. (10). The novelty here is the study population; that is, the thousands of heart failure patients living in nearby communities affected by UNGD, which enabled McAlexander et al. (9) to investigate heart failure exacerbation leading to hospitalization. The authors found that heart failure patients who were exposed to the highest quartile of UNGD activity were more likely to be hospitalized for heart failure compared with those who were in the lowest quartile of the exposure. The group described a biological gradient that patients with severe heart failure (higher Charlson index of morbidity) were more susceptible to the UNGD activity metric. Many of the postulations on the possible mechanistic pathways come from our understanding of air pollution effects on cardiovascular diseases, which include systemic inflammation, autonomic dysfunction, prothrombotic pathways, and epigenomic changes (11).
In the early 2010s, the scientific community was calling for “good” epidemiological studies to evaluate the health effects of fracking (12,13). In the current observational study, McAlexander et al. (9) applied extensive and rigorous methods involving both the design and the statistical approach. First, the study used negative exposure controls. This is a precautionary tool to assess sources of spurious causal inference (14). In brief, the authors assigned future exposure to outcomes that happened in the past. This temporal mismatch should not yield meaningful or adverse effects, and if it did, then there could be an unmeasured spatial confounder that is accounting for the observed relationship. Second, the authors conducted a number of sensitivity analyses, including restricting age groups, alternative measures of patients’ duration of care, and different functional forms of the exposure metric. Third, they controlled for a wide range of covariates. Their results were consistent and robust across all these measures. Most importantly, the effect size is probably too large to be explained away by an unmeasured confounder. To illustrate this, one can calculate the E-value, which is the minimum strength of association that an unmeasured confounder would need to have with both the exposure and the outcome, conditional on the measured covariates, to fully explain away a specific exposure–outcome association (15). If we apply this on the reported odds ratio comparing the fourth quartile of the UNGD activity metric versus the lowest quartile in the pad preparation phase (odds ratio: 1.70; 95% confidence interval: 1.35 to 2.13; model 5), we will then need to think of some unmeasured confounder that has a relative risk association of at least as large as 1.93 (1.60 for the confidence interval) with both UNGD pad preparation and heart failure hospitalization to explain away the observed association. If anything, the observed results are likely attenuated toward the null due to possible nondifferential misclassification bias in the case ascertainment and exposure assessment.
As the epidemiological evidence starts to accumulate, there are many challenges yet to be addressed that preclude our full understanding of the potential health effects from UNGD on nearby local communities. First, exposure assessment needs to be advanced toward understanding the specific mechanisms in which UNGD can affect health outcomes. For example, a recent study showed that particle radioactivity (particulate matter that transports high-energy alpha-emitting radionuclides from the external environment to human tissues through inhalation) is a potential exposure pathway of UNGD (16). Moving forward, we need to better understand the mediating effects by air and water pollutants, as well as particle radioactivity, and the existence of racial disparities in the fracking impacts. We also need a better understanding of the effects of various environmental exposures on cardiovascular health. Fine-tuning of cause-specific cardiovascular morbidity and mortality along with translational studies are needed to further characterize the pathophysiological pathways.
Study: PA heart failure patients near fracking were more likely to be hospitalized, 12,000 patients analyzed over 8-year period by Reid Frazier, December 21, 2020, State Impact
Heart failure patients who live near fracking operations were more likely to be hospitalized than those who live farther away, according to a new study.
Researchers at Drexel and Johns Hopkins studied medical records of 12,000 heart patients in Pennsylvania between 2008 and 2015.
The authors reported “significantly increased odds of hospitalization among heart failure subjects in relation to increasing” fracking activity in the area near them. Heart failure includes any condition, like a heart attack, that leads to the inability of the heart to pump enough blood to meet the body’s needs.
Older patients and those with more severe heart failure “seem particularly vulnerable to adverse health impacts” from nearby fracking, the authors stated.
The study appeared in the Journal of the American College of Cardiology. The study was funded by grants from the National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health.
The study’s lead author, Tara McAlexander, a post-doctoral research fellow in the Department of Epidemiology and Biostatistics at the Dornsife School of Public Health at Drexel University, said that increased noise, air pollution, and traffic from fracking could all explain the higher levels of heart patient hospitalizations found in their study.
“We thought about all those potential exposures and how they might impact heart failure. And pretty much all of them really suggested that they would be exacerbated if you were exposed (to fracking) and you were in that vulnerable state of having heart failure in the first place.”
The authors reported they did not have data on the diet or lifestyle of the study’s subjects, but doubted whether the higher hospitalization rates they observed in heart patients living near fracked gas wells could be chalked up to those factors.
Joan Casey, assistant professor in environmental health sciences at Columbia University, said in an email the study “adds to mounting evidence that fracking is related to adverse health outcomes.”
Casey, who worked with some of the paper’s co-authors when she was a graduate student at Johns Hopkins University, but was not involved in the study, said it suffered from the same limitations “of essentially all epidemiologic studies of fracking to date: we don’t know what component of fracking is responsible. Is it air pollution? Water pollution? Noise pollution? Psychosocial stress? Something else?”
Casey also pointed out the study ends in 2015 “and so may not reflect current fracking exposures in Pennsylvania.”
Zach Rhinehart, assistant professor of cardiology at the University of Pittsburgh School of Medicine, said there have been calls for “high quality evidence” about fracking and health impacts for years.
He said the study’s statistical model was strong enough to essentially rule out any other causes besides fracking for the increased hospitalizations the authors found.
Fracking “really does seem to be associated with hospitalization for heart failure,” said Rhinehart, who was not involved in the study. “And it doesn’t seem like any other(factors) are explaining that away.”
Rhinehart said that because fracking plays a big role in the state’s economy and energy portfolio, “it would be really important to know what about it is causing the problem.”
“You can’t dismiss the fact that the natural gas development is a major economic driver and it’s something that’s very important to many people’s livelihoods,” Rhinehart said. “So it’s really important to find out why is this association there?”
McAlexander said the study fits with a growing list that shows increased health problems for people who live near fracking. Those problems include increased incidence of asthma, heart problems, and mental health issues, as well as health problems related to pregnancy, like birth defects, pre-term birth and low birthweight.
“These activities — unconventional natural gas development and fracking specifically — are having negative impacts on the health of populations living nearby.”
She says because of this, she thinks fracking should be banned.
“We know enough to know that we shouldn’t be doing this and that it’s negatively impacting populations,” McAlexander said.
Another co-author, Brian Schwartz, professor in the Department of Environmental Health Sciences in the Johns Hopkins Bloomberg School of Public Health, has publicly come out against fracking.
McAlexander acknowledged that burning natural gas instead of coal has resulted in widespread air quality gains in the U.S., but said “the way the natural gas industry produces natural gas in this country, it shifts a lot of those health burdens to nearby populations.”
Nate Wardle, a spokesman for the Pennsylvania Department of Health said the agency is reviewing the study. The agency is funding a pair of studies to look at the relationship between fracking and health outcomes like cancer, asthma and poor birth outcomes.
“It is the department’s goal through these studies to better understand both long term impacts and short term, acute impacts,” Wardle said, in an email.
A spokesman for the Pennsylvania Department of Environmental Protection, asked to comment on the study, said only that the agency would be “reviewing the (Department of Health) study,” which is slated to be completed in December 2022, and that the agency “will consider” the study and others like it when it revisits its oil and gas regulations in the future.
A June 2020 Pennsylvania grand jury report slammed both the DEP and the health department for failing to protect the public from the health effects of fracking.
Fracking industry groups say they are “safely and responsibly” developing the state’s natural gas resources while meeting the state’s requirements for the industry.
“Our industry is grounded in advanced scientific research, and protecting the health and safety of communities where we live and operate is our highest priority,” Marcellus Shale Coalition President Dave Spigelmyer said, in a statement. Where’s the proof the industry is “grounded” in advanced scientific research? CEOs publicly admit companies do not know what they are doing, that frac’ing is a “brute force and ignorant” experiment.
And we are now finding out, a decade later, some frac’ers only made “a lot of money” because they scammed banks and investors! Now that investors have caught on, money is fast drying up, with frac’ers bankrupting themselves all over the carpet-bombed place.
Companies, regulators, politicians and too many courts only want the frac-harmed gagged and don’t give a shit about health and safety – in Canada, Australia, the USA and everywhere else where industry is frac’ing. Lobby groups like CAPP and Marcellus Shale Coalition further harm us, our loved ones and communities, with their incessant lying and propagandizing.
Rhinehart, of the University of Pittsburgh, said any negative health outcomes from fracking should be balanced against whatever positive factors the industry brings to those it benefits — like workers or landowners who have leased property for gas drilling.
“Maybe now they can afford their blood pressure medicines or their cholesterol medicine or smoking cessation aides,” Like a rapist, the patronizing prof insults and blames the harmed. As vile as AER’s outside counsel, Glenn Solomon, admitting that law-violating frac’ers gag the harmed so that companies can “do it again down the street.” Rhinehart said. “It could be…that the economic benefits from this allow more people to live better lives and to be happier and healthier despite the negative effects of the pollution.”What amount of money makes being poisoned to the point of being hospitalized and or killed OK? One million dollars, a billion? Many that signed leases in North America were conned just like investors were and are paid not one penny for their troubles and the endless harms, even with signed contracts! Worse, too many companies refuse to pay their taxes and refuse to clean up after they rape out profits, dumping ongoing harms, leaks, pollution, clean up on the harmed and taxpayers.
Refer also to:
Yup, frac’ing is an experiment alright, a brute force, ignorant, extremely harmful one:
2006 12: When I discovered my community’s drinking water aquifers were deliberately illegally frac’d by Encana/Ovintiv with 18 Million liters of frac fluid and undisclosed additives, and years of lies by Encana/Ovintiv, regulators and politicians, all hope in me died.
2013 02 19: FOIP letter from AER (previously ERCB) on all fracks gone bad in Alberta. Imagine the results if this FOIP were done today!
2013: Alberta gov’t brings in REDA (a ridiculously dishonest name), changing the regulator to AER (apparently in response to Ernst’s lawsuit), removes public interest from its mandate
2013 07 31: “Nobody understands” leaks at Alberta tar sands high pressure injection operation, Leaks in Cold Lake have been going on for weeks with no end in sight, according to a government scientist
It can get pretty testy. Encana fracked somebody else’s well – in yet another case of “involuntary stimulation”
2015 10 20: more fraud in the frac patch? Trying to cover-up a major frac hit by blaming vandalism? 6.4 km long North Dakota oil well spews more than 67,000 gallons of crude & 84,000 gallons of brine for days
2015 10 22: If frac’ing is safe & wonderful, why so many gag orders, why is fracking killing hope, people, fish, animals, vegetation, water, air, soil, and busting caprock? Why so much fraud by regulators, politicians, companies, NGOs, experts, academics etc covering up murderous corporate crimes: threats, bullying, abuse; dropping rodent shit into water wells of the harmed; trespassing, home invasions, interrogations of harmed families by police; intimidation; “terrorist” labeling to violate rights of citizens filing lawsuits? George Bender “died of a broken heart” says family.
2015 12 01: “Abnormally dangerous and ultra hazardous activity.” Did TRC or Chevron’s fracing kill Robert David Taylor? What happened to California regulators’ vows to make steam injections safer? “Safer?” Why not make it “safe?”
2016 03 15: Dr. John Cherry Shale Gas Recommendation: Frack ‘n Track Us. Cherry needs to sign his family up first. How’d he like his loved ones to be subjects of a polluted-ass-tracking study living with thousands of fracs & refracs, even into his drinking water supply, for a decade and more?
2016 07 18: 8-year frac health study shows fracking associated with increased asthma attacks: “Those who lived closer to a large number or bigger active natural gas wells were significantly more likely…to suffer asthma attacks” … “The highest risk for asthma attacks occurred in people living a median of about 12 miles from drilled wells. The lowest risk was for people living a median of about 40 miles away.”
2016 10 29: Andrew Nikiforuk honoured with USA National Science in Society Award for Slick Water. “NASW’s Science in Society Journalism Awards honor and encourage outstanding investigative and interpretive reporting about the sciences and their impact for good and ill.”
2016: New York signs law prohibiting fracking, and oil, natural gas waste in city. NORM increasing because of unconventional oil & gas, “has become a much more significant health, safety and environmental issue”
2017: Nasty! Supreme Court of Canada pisses on the rule of law, damages Canada’s Charter and knowingly lies in their ruling in Ernst vs AER. Worse, the court sends the lie to the media but not the part of their ruling where the lie is specified as such.
2017: Ireland bans frac’ing! “Victory for the long term.” Frac bill passed in Dail! “The scientific evidence overwhelmingly shows that permitting fracking in Ireland and Northern Ireland would pose significant threats to the air, water and the health and safety of individuals and communities here.”
2017 03 01: Albania’s deputy prime minister declares villagers with homes damaged by Canada’s Bankers Petroleum to get full compensation. What do frac harmed in Canada get? Regulator fraud & cover-up; bullying, intimidation & harassment by authorities, even RCMP; secrets & lies; cowardly elected officials enabling more harms; AER violating Charter rights with Supreme Court of Canada fabricating “facts” for the AER
2017 03 18: Frack “Pump & Pray” Research & Development: Cut safe practices to increase profits? ConocoPhillips to test new fracking tech, Working on pilot project with service providers to develop cost-effective multi-lateral fracking
2017 08 15: Legal matters: Fracking the golf course. Ask Indian Hills Golf Course, Lambton Shores, Ontario: Did nature, waste injection, gas storage or fracking causing massive natural gas geysers and erupting greens in 2015? Two municipalities declared state of emergency, Golf Course had to shut down, pay to investigate and clean up
2017 09 21: Oklahoma Kingfisher County: At Least 450 Vertical Oil Wells Damaged By Horizontal Fracking. “Hundreds if not thousands of wells are being destroyed by horizontal frac jobs.” How many oil & gas & drinking water wells damaged by fracking (vertical and horizontal) in Alberta?
2017 11 01: “Frack Well Bashing” is going to get expensive! Frack Hit Demolition Derby Down Below: Drill, inject, bump ‘n crack, hit ‘n smash, bash ‘n dash, while Encana lies ‘n says, “We don’t frac. We stimulate.” 2 wells, 1 patch of dirt. Who gets the oil? The biggest bully. “Fracks hitting wells several miles away.”
2017 11 11: To Honour the Fallen on Remembrance Day: Make public AER’s secret “D79 Abandoned Well Methane Toxicity Preliminary Assessment” & Appendix 2 by Alberta Health, Admitting “Acute-Life threatening” risks & “Neurological effects”
2017 11 22: How did this get past Trump, Encana, CAPP, Energy in Depth etc? The Journal of the American Medical Association Publishes Concerns about Fracking Contaminating Air and Drinking Water, and Harming Human Health!
2018 02 15: Oil & gas industry’s fracking is “perfectly safe” lie explodes by homes, yet again: Ohio, Belmont County, XTO Well pad explosion, fire forces 1 mile mandatory evacuation area; Families & businesses within 2 miles urged to evacuate, 2/3s of Village of Powhatan
2019 10 01: Oklahoma Kingfisher-Blaine County line: Another frac hit? Industry-caused damaging earthquake? Officials believe related to oil & gas industry: 3,000 gallons “highly toxic saltwater bubbling to surface every day.” Regulator: “Something you never want to see, is something bubbling to surface like this.”
2019 06 30: Canada’s widespread denial of access to “justice.” Ontario judge awards plaintiff more than 10 times her net damage award in costs, plaintiff still loses financially! Just like when Justice Neil C Wittmann awarded 3 times costs to Ernst, but she hugely lost financially because Alberta’s anti-justice system gave govt *3* chances to try to throw out her lawsuit (the third granted by J Wittmann)
2019 07 28: IT’S A BIG ONE! AER Order against Sprocket Energy sour gas well leak/spill (by frac hit?) six km SW of Town of Fox Creek. Why no media coverage on possibly life-threatening, brain damaging leak near busy Smoke Lake Provincial Park Campground?
2019 11 01: UK: Tory Gov’t bans frac’ing! In Canada, when frac harms ramp up and industry demands deregulation, regulators deregulate. UK decision taken after new scientific study warns it’s not possible to rule out “unacceptable” consequences for those living near frac sites
2019 11 03: 8,000 acres evacuated/roads shut near Yorkton, South Texas because of Devon Energy’s Natural Gas & Condensate Blowout. Raging Three Days. Record high levels of benzene, 8 ppb, on state air monitor, Karnes City, 30 miles away.
2019 11 12: Encana’s Vexatious Sour Gas Frack Flaring near Grand Prairie, Alberta; After clip posted, Encana pulls a scrubby dubby (removes from public access their emergency response plan for the area and runs away to the USA as Ovintiv).
Updated Nov 12, 2019: Shortly after Will Koop posted his clip (above), Encana removed its Grand Prairie Emergency Response Plan (ERP) from the Internet. It’s vital that such important documents relating to public health and safety are accesible, so it has beenuploaded here (takes time to load).
2019 12 18: Look out Albertans whose pensions Kenney gave to AIMCo. Crazy Days in Alberta: The Poison Wells File. The province let oil and gas firms create a $100-billion disaster. New example? Shell Pieridae Briko Ikkuma Alberta Foothills Sour Gas Marriage financed by AIMCo and about $10Billion in liabilities.
2020 01 19: Meet “NoHIT.” More toxic brew to be intentionally injected into our environment to feed the “brute force and ignorant” frac experiment? Chemical company, TenEx Technologies, has scary idea to inject aluminum and who knows what else to prevent ‘frac hits’
2020 06 03: Another new study: Living near oil & gas wells tied to low birth weights in infants, adds to growing body of evidence linking proximity to oil & gas to adverse health outcomes, including heart defects, cancer …
2020 08 02: New study concludes UK gov’t ignored public health concerns while heeding frac and chemical industries. In Canada, authorities withhold official reports warning of frac harms; help frac’ers cover-up crimes and enable them to further harm families after they get sick. Most vile, AER’s (no health mandate) Dr. Monique Dube (not a health professional) wrote lying “health” reports about frac’d families and unlawfully made them public online, via Synergy, etc.
The UK Government and its advisers “marginalised, downplayed or ignored” public health concerns about shale gas exploration and fracking in England, new research has concluded.
A study by the University of Stirling found that science was frequently ignored and the shale gas industry was very effective in influencing decision-making.
This had been to the detriment of public health, with vulnerable and disadvantaged communities at the greatest risk, it said.
2020 07 23: Frac Tank Reality Show: “Debt, Debt and Debt” and more debt; Judge-gifted bankruptcies to keep companies frac’ing & polluting and con investors into losing more money; Abandon thousands of frac harmed families; And intentionally dump pollution and clean-up on taxpayers. In the USA, “explorers burned through some $342 billion of cash since 2010, leaving little in the way of returns for investors.” In Alberta, AIMCo took $100s of millions (under Kenney & Harper, will likely take $billions more) from pensioners years ago to give to “quite leveraged” frac’ers already then.
2020 10 15: New Study: Airborne radioactivity increases downwind of frac’ing; Particles released could damage health of residents nearby. Marco Kaltofen: “This investigation backs up its big conclusions with big data.” Petros Koutrakis, Harvard TH Chan School of Public Health in Boston, led the study: “If you asked me to go and live downwind [of fracking sites], I would not go.”
2020 10 23: Frac’ing Beautiful British Columbia: No regard for community, family, farms, wildlife; No Environmental or Cumulative Impact Assessments; No care for water or the lives of others, just spin, lies & broken promises; Premier John Horgan, his Dancing NDPipers and OGC heed demands of multinational corporate polluting abusers while ignoring the environment and harmed
Frac’ers are never satisfied; they always demand more wells, more facilities, more deregulation, more billions in subsidies and freebies as they lose more billions for investors and cause more harm upon harm.
Hellish infrastructure and expansion as far as the eye can see.
“What regulation or law fixes this?” (Hint: None, other than criminalizing frac’ing.)
2020 12 14: A decade of science on frac harms – Compendium 7 released: “The data continue to reveal a plethora of recurring problems that cannot be sufficiently averted through regulatory frameworks” while regulators in Canada continue to DEregulate to enable the endless **known** harms. Canadian frac-harmed Vicky Simlik: “Because there is no such thing as a kind & gentle frac’ it needs to be banned period.”
2020: As of the date of this post, still no federal or provincial health or energy regulatory agency in Canada provided Ernst and her community or the many others harmed by frac’ing any help (and, the courts and Ernst’s own lawyers, Murray Klippenstein and Cory Wanless, lied and punished Ernst, devoutly pissing on the public interest and rule of law).
Our illegally frac’d drinking water aquifers remain frac’d by Encana/Ovintiv, a cowardly bully company that has run away to the USA.
Ernst’s presentation in Malton, North Yorkshire, UK. It sums things up.
To read more galling details about how Encana/Ovintiv and the regulators and courts treated the public interest and me, read Andrew Nikiforuk’s Slick Water.