Residence in coal-mining areas and low-birth-weight outcomes

Lung function in children residents in the largest coal region in Brazil

Coal mining activities release harmful air pollutants, which affect children's health, particularly the lung function. Brazil has a large coal reserve in the southern region, where a coal-fired power plant and two coal mines are located. The study aimed to evaluate the prevalence of altered respiratory function and associated factors in children living in this region. A cross-sectional study was conducted in seven cities. It collected socioeconomic and demographic, prenatal and postnatal care, neonatal outcomes, child health information as well as lung function and air quality. The study included 396 children who lived in a high socio-environmental vulnerability due to low education levels and family income, high percentage of unemployed and families with a high bedroom density. There was a high prevalence of preterm birth, low birth weight and long-term exposure to environmental conditions. The most common respiratory problem in the parents was rhinitis, while in the children was wheezing and pneumonia. The prevalence of respiratory function alteration in the region was 7.78%. Variables associated with altered respiratory function were passive smoking, low birth weight, history of wheezing. The concentration of pollutants was equivalent when comparing stations within the coal mining host town (Candiota) and surrounding towns.

Multiple exposure pathways and health risk assessment of potentially harmful elements for children and adults living in a coal region in Brazil

Energy generated by coal can contaminate the environment by releasing toxic elements, including metals. The human health risk assessment (HHRA) associated with geographic information system (GIS) tools can assist the management of contaminated areas, such as coal mining areas. The objective of the study was to carry out the assessment and spatialization of the risk to human health of potentially hazards elements (PHEs) in the soil for children and adults, from multiple exposure routes (oral, inhalation and dermal) in the Candiota mines, largest coal mining region of Brazil. The non-carcinogenic risks (HQ) of PHEs (Cu, Pb, Zn, Ni, Cr, Fe, Mn, Cd, As and Se) and carcinogenic risks of As were estimated and spatialized. The results revealed a risk for children exposure to Mn, with greatest contribution through dermal route. Mn (HQ_derm 72.41-96.09% and HQ_inh 40.84-82.52%) and Fe (HQ_o 43.90-81.44%) were the metals with greatest contribution to human health risk among studied population. As did not present carinogenic risk to adults. The spatial distribution of non-carcinogenic risk showed that Cr, As, Fe, Pb, Ni, Zn and Cu have higher HInc close to the coal mining areas, while Mn, Se and Cd have the highest HInc values in surrounding municipalities (Pinheiro Machado; Pedras Altas and Hulha Negra). The use of HHRA associated with GIS tools provides important elements for decision-making in the management of contaminated sites, indicating chemical elements, locations, routes of exposure and priority target populations.

Associations Between Surface Mining Airsheds and Birth Outcomes in Central Appalachia at Multiple Spatial Scales

A considerable body of research exists outlining ecological impacts of surface coal mining, but less work has explicitly focused on human health, and few studies have examined potential links between health and surface coal mining at fine spatial scales. In particular, relationships between individual birth outcomes and exposure to air contaminants from coal mining activities has received little attention. Central Appalachia (portions of Virginia, West Virginia, Kentucky, and Tennessee, USA), our study area, has a history of resource extraction, and epidemiologic research notes that the region experiences a greater level of adverse health outcomes compared to the rest of the country that are not fully explained by socioeconomic and behavioral factors. The purpose of this study is to examine associations between surface mining and birth outcomes at four spatial scales: individual, Census tract, county, and across county-sized grid cells. Notably, this study is among the first to examine these associations at the individual scale, providing a more direct measure of exposure and outcome. Airsheds were constructed for surface mines using an atmospheric trajectory model. We then implemented linear (birthweight) and logistic (preterm birth [PTB]) regression models to examine associations between airsheds and birth outcomes, which were geocoded to home address for individual analyses and then aggregated for areal unit analyses, while controlling for a number of demographic variables. This study found that surface mining airsheds are significantly associated with PTB and decreased birthweight at all four spatial scales, suggesting that surface coal mining activities impact birth outcomes via airborne contaminants.

Gestational and Neonatal Outcomes in Cities in the Largest Coal Mining Region in Brazil

Brazil has one of the largest mineral coal reserves in the world. More than 40% of this ore is in the Candiota Mine, in the extreme south of Brazil, which was previously identified as a hotspot of environmental pollution. In addition, an important part of Brazil's population suffers from socioeconomic vulnerability. Since there is no information on unfavorable gestational and neonatal outcomes associated with these problems, we conducted a cross-sectional study with 1950 mother-child binomials, aiming to evaluate the association between these outcomes and air pollution as well as socioeconomic, demographic and health variables in seven cities in the region. Of the total births, 11.6% were preterm and 9.5% of neonates had low birth weight (<2500 g). These conditions were also associated with skin color, previous abortions, birth type and prenatal care, as well as exposure to higher levels of coarse particulate matter (PM10) during the first trimester of pregnancy. Regarding air pollutants, although the daily limits for PM10 were exceeded on less than 5% of days, the annual average overtook the values proposed by WHO. Thus, we concluded that prematurity and low birth weight in this region are related to air pollution, and to socioeconomic variables and health care.

Lung function among residents from the largest coal region in Brazil

Coal mining and burning activities in coal-fired power plants are among the most polluting activities in developing countries. In Brazil, the Candiota coal deposit concentrates 40% of the national mineral coal. Although, previous studies indicate several negative health outcomes to residents of this coal region, there is no information about lung function. Thus, this study aimed to evaluate lung function by spirometry among residents from the largest coal mining region of Brazil and its related factors. It was carried out a cross-sectional study with 300 male adults residing in four cities from this region. Socioeconomic, demographic, life style, and health conditions were collected through a structured questionnaire, and lung function was assessed by spirometry. Almost 18% of the residents have disorders in pulmonary function. There was significant statistical difference in the spirometry main parameters between the cities. Candiota city (host city of coal exploration activities) have the highest prevalence of obstructive ventilatory disorder. Curiously, upper economic class had significant higher risk of altered lung function (P<0.001), as well as inappropriate sewage destination (P<0.001). Residents of Candiota city had 20% higher risk of altered lung function. Regarding air quality, the PM₁₀, SO₂, and NO₂ of the region were 20.6± 3.9, 7.0± 2.2, and 6.0± 1.6, respectively. Two air quality stations exceed the limit of 20 μg/m³ to PM₁₀ proposed by Brazilian legislation and WHO, and three stations had PM₁₀ quite close to the limit. This study points out the need for urgent action to protect residents from this coal mining region.

Identifying exposure pathways mediating adverse birth outcomes near active surface mines in Central Appalachia

Background

Previous work has determined an association between proximity to active surface mining within Central Appalachia and an increased risk of preterm birth (PTB) and low birthweight (LBW). Multiple potential exposure pathways may exist; however, including inhalation of particulate matter (airshed exposure), or exposure to impacted surface waters (watershed exposure). We hypothesize that this relationship is mediated by exposure to contaminants along one or both of these pathways.

Methods

We geolocated 194,084 birth records through health departments in WV, KY, VA, and TN between 1990 and 2015. We performed a mediation analysis, iteratively including within our models: (a) the percent of active surface mining within 5 km of maternal residence during gestation; (b) the cumulative surface mining airshed trajectories experienced during gestation; and (c) the percent of active surface mining occurring within the watershed of residency during gestation.

Results

Our baseline models found that active surface mining was associated with an increased odds of PTB (1.09, 1.05-1.13) and LBW (1.06, 1.02-1.11), controlling for individual-level predictors. When mediators were added to the baseline model, the association between active mining and birth outcomes became nonsignificant (PTB: 0.48, 0.14-1.58; LBW 0.78, 0.19-3.00), whereas the association between PTB and LBW remained significant by airshed exposure (PTB: 1.14, 1.11-1.18; LBW: 1.06, 1.03-1.10).

Conclusions

Our results found that surface mining airsheds at least partially explained the association between active mining and adverse birth outcomes, consistent with a hypothesis of mediation, while mediation via the watershed pathway was less evident.

Recent Developments in Microbe-Plant-Based Bioremediation for Tackling Heavy Metal-Polluted Soils

Soil contamination with heavy metals (HMs) is a serious concern for the developing world due to its non-biodegradability and significant potential to damage the ecosystem and associated services. Rapid industrialization and activities such as mining, manufacturing, and construction are generating a huge quantity of toxic waste which causes environmental hazards. There are various traditional physicochemical techniques such as electro-remediation, immobilization, stabilization, and chemical reduction to clean the contaminants from the soil. However, these methods require high energy, trained manpower, and hazardous chemicals make these techniques costly and non-environment friendly. Bioremediation, which includes microorganism-based, plant-based, microorganism-plant associated, and other innovative methods, is employed to restore the contaminated soils. This review covers some new aspects and dimensions of bioremediation of heavy metal-polluted soils. The bioremediation potential of bacteria and fungi individually and in association with plants has been reviewed and critically examined. It is reported that microbes such as Pseudomonas spp., Bacillus spp., and Aspergillus spp., have high metal tolerance, and bioremediation potential up to 98% both individually and when associated with plants such as Trifolium repens, Helianthus annuus, and Vallisneria denseserrulata. The mechanism of microbe's detoxification of metals depends upon various aspects which include the internal structure, cell surface properties of microorganisms, and the surrounding environmental conditions have been covered. Further, factors affecting the bioremediation efficiency and their possible solution, along with challenges and future prospects, are also discussed.

Human health risk assessment of metals and anions in surface water from a mineral coal region in Brazil

Coal mining releases high concentration elements to the environment, which can be deposited in surface water, causing several human health problems. Candiota mine in the south of Brazil is the largest coal reserves in the country, representing approximately 40% of total national coal reserves. Therefore, the present study aimed to estimate the chronic daily dose and the non-carcinogenic risk index for metals and anions in surface waters of Candiota Region, using the USEPA protocols for Human Health Risk Assessment. A total of eight water samples were collected over a distance of up to 15 km from the emission sources of the thermal power generation companies, then the Chronic Daily Intake (CDI), Hazard Quotient (HQ), Hazard Index (HI), and sum of Hazard Index (ΣHI) were calculated. All the elements and anions evaluated showed natural concentrations for continental fresh waters according to Brazilian legislation, except Pb. Individually, none of the metals Pb, As, Cd, Ni, and Se or anions F^- and NO₃^- showed an HI value greater than 1. However, the sum of HI (ΣHI) (five metals and two anions) by sample point showed values close to 1, for one of the eight points analyzed. Pb and Fe were the elements that most contribute to the risk values in the sample points of the study area. Although, there is no human health risk in this scenario, this investigation highlight priority elements to future investigations in coal mine areas. In the current region, Pb and F^- as priority elements for future studies.

Maternal, neonatal and socio-economic factors associated with intellectual development among children from a coal mining region in Brazil

Coal is the most aggressive energy sources in the environment. Several adverse outcomes on children's health exposure to coal pollutants have been reported. Pollutants from coal power plants adversely affect the intellectual development and capacity. The present study aimed to evaluate the intellectual development and associated factors among children living a city under the direct influence (DI) and six neighboring municipalities under the indirect influence (II) of coal mining activity in the largest coal reserve of Brazil. A structured questionnaire was completed by the child's guardian, and Raven's Progressive Color Matrices were administered to each child to assess intellectual development. A total of 778 children participated. In general, no significant difference was observed between the two cities. The DI city had better socioeconomic conditions than the II municipalities according to family income (< 0.001). The prevalence of children who were intellectually below average or with intellectual disabilities was 22.9%, and there was no significant difference (p > 0.05) between municipalities. In both unadjusted and adjusted analyses, intellectual development was associated with maternal age, marital situation and maternal education level, birth weight, breast feeding, frequent children's daycare, paternal participation in children's care and child growth. Living in the DI area was not associated with intellectual disability. The results suggest that socioeconomic conditions and maternal and neonatal outcomes are more important than environmental factors for intellectual development of children living in a coal mining area.

Surface mining and low birth weight in central appalachia

BACKGROUND

Surface mining has become a significant method of coal mining in the Central Appalachian region of the eastern United States alongside the traditional underground mining. Concerns have been raised about the health effects of this surface mining, particularly mountaintop removal mining where coal is mined upon steep mountaintops by removing the mountaintop through clearcutting forests and explosives.

METHODS

We used a control group design with a pretest and a posttest to assess the associations of surface mining in Central Appalachia with low birth weight and other adverse birth outcomes. The pretest period is 1977-1989, a period of low surface mining activity. We consider three posttest periods: 1990-1998, 1999-2011 and 2012-2017, with 1999-2011 as the primary analysis and the other periods as secondary analyses. Surface mining in Central Appalachia increased after 1989, partly resulting from the Clean Air Act Amendments of 1990 which made surface mining in Appalachia more financially attractive. For the primary analysis, we fit a logistic regression model of the primary outcome (low birth weight, <2500 g) on dummy variables for county and year; individual level maternal/infant covariates (maternal race, maternal age, infant sex and whether birth was a multiple birth); and the amount of surface mining during the year of the birth in the maternal county of residence.

RESULTS

Our analysis sample consisted of 783,328 infants -- 482,284 infants born from 1977 to 2017 to women residing in substantial surface mining activity counties and 301,044 infants born from 1977 to 2017 to women residing in matched control counties. Compared to the pre-period of low surface mining from 1977 to 1989, for the primary analysis posttest period of 1999-2011, there was an estimated relative increase in low birth weight in surface mining counties compared to matched control counties that was not statistically significant (odds ratio for a 5 percentage point increase in area disturbed by surface mining: 1.07, 95% confidence interval (0.96, 1.20), p-value: .22). For the secondary analysis posttest period of 1990-1998, there was no increase (odds ratio: 0.91, 95% confidence interval: (0.74, 1.13), p-value: .41). For the secondary analysis posttest period of 2012-2017, there was a statistically significant relative increase (odds ratio: 1.28, 95% confidence interval: (1.08, 1.50), p-value: .004). Qualitatively similar results were found for the outcomes of very low birth weight, preterm birth and small-for-gestational age.

CONCLUSIONS

We examined the hypothesis that surface mining activity in Central Appalachia contributes to low birth weight using an observational study. We found evidence in secondary analyses that surface mining was associated with low birth weight in the 2012-2017 time period and potentially beginning in the early to mid 2000's. Evidence for an association was not found prior to 2000. A potential explanation for this pattern of association is that surface mining caused an increase in low birth weight but its onset was delayed. Future research is needed to clarify the findings and if replicated, identify the mechanism necessary to mitigate the impacts of mining on adverse birth outcomes.

Multiple exposure pathways and health risk assessment of selenium for children in a coal mining area

Selenium (Se) presents a dual role to human body, harmful or beneficial, depending on its concentration. The exposure to this element has been associated to coal mining. Health risk assessment allows estimating and evaluating the risks that environmental hazards pose to vulnerable groups of populations. The present study aimed to analyze the risk of exposure to Se through multiple exposure pathways in children living in Candiota city, where the largest coal reserve of Brazil is located. Data from previous environmental (air, soil, drinking water, and food) and population parameters (age, weight, and food intake) were used to assess the health risk, which was calculated with real values (extracted from the population) and fixed reference values, based on the USEPA recommendation. Most of the children had low health risk (HQ < 1); however, in the most conservative scenarios (higher Se values in the different matrices), there was a high health risk in both scenarios, using population data or the USEPA parameters. The mean HQ using reference values was twice higher than using real values. Se content in air, soil, and drinking water did not represent important average daily dose in both scenarios. While, food intake was a main source of Se exposure, contributing with 96.9% of total Se intake. The findings of this study reinforce the importance of food intake for exposure to Se and the difference between HQs using population measures and fixed parameters of the USEPA highlights the need for adaptations to local scenarios for a better dimensioning of toxicological risk management actions.

Maternal proximity to Central Appalachia surface mining and birth outcomes

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Maternal residency in Central Appalachia counties with coal production has been previously associated with increased rates of low birth weight (LBW). To refine the relationship between surface mining and birth outcomes, this study employs finer spatiotemporal estimates of exposure.

Selenium dietary intake, urinary excretion, and toxicity symptoms among children from a coal mining area in Brazil

Selenium (Se) is necessary for several physiological functions in the human body; however, high concentrations of this element in coal mining areas raise the possibility of Se-related health risks. Children are much more vulnerable and at risk to environmental hazards than adults. The largest coal mining area of Brazil is located in the city of Candiota, where previous studies point to significant urinary Se concentrations among children. Food intake is the main Se source. The study aimed to evaluate dietary Se intake, as well as urinary Se excretion and classic symptoms of Se intoxication among children from Candiota and a control city in the same region. A cross-sectional study was carried out, with participation from 242 children between 6 and 12 years old in two cities in Rio Grande do Sul state, Brazil. Socioeconomic variables, dietary intake, and Se toxicity symptoms were evaluated through a structured questionnaire, and urinary Se levels were measured. Children from both cities had normal levels of Se intake and urinary excretion; however, children from Candiota had significantly higher levels of Se in both parameters in relation to the control city, especially for Se urinary excretion. There was low prevalence of Se toxicity symptoms. We conclude that coal mining activities may increase Se intake in children and consequently its urinary excretion.

Association between DNA damage, dietary patterns, nutritional status, and non-communicable diseases in coal miners

Several negative health effects have been associated with environmental pollution. Coal mining activities are related to DNA damage. However, the impact of lifestyle as well as environmental exposure must be considered when evaluating the extent of DNA damage. The aim of this cross-sectional study was to analyze nutritional status, dietary patterns, and the prevalence of non-communicable diseases (CNCDs) among coal miners as well as to investigate the correlation of these variables with DNA damage. We used a questionnaire to assess demographics, health, and dietary habits. The nutritional status was measured in terms of BMI (body mass index) and DNA damage was assessed by the comet assay. The sample population was composed of 158 coal miners from the largest coal mining company in South of Brazil, and majority of them were classified as overweight (51.3%) or obese (28.5%). Hypertension was the most common CNCD (50.6%) and a majority of these workers consumed all groups of foods three or more times a week. There was a significant positive correlation between BMI and DNA damage (r = 0.1646, p = 0.04) and this association was stronger (r = 0.2556, p = 0.04) in coal miners with some CNCD. There was no significant correlation between dietary patterns and DNA damage in coal miners. These results suggest that the nutritional status and CNCD increase the extent of DNA damage in coal miners. Since this population is at high occupational risk, specific strategies should be designed to improve the health of these workers, aiming to achieve health equity.

Hazardous Air Pollutants and Adverse Birth Outcomes in Portland, OR

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The impact of multiple hazardous air pollutant (HAP) exposures during pregnancy on adverse birth outcomes is unknown. We examined associations between cumulative and individual HAP exposures and adverse birth outcomes in Portland, OR, a region that has exceeded HAP air quality guidelines for decades.

Spatial identification of environmental health hazards potentially associated with adverse birth outcomes

Reduced birth weight (RBW) and reduced head circumference (RHC) are adverse birth outcomes (ABOs), often linked to environmental exposures. However, spatial identification of specific health hazards, associated with these ABOs, is not always straightforward due to presence of multiple health hazards and sources of air pollution in urban areas. In this study, we test a novel empirical approach to the spatial identification of environmental health hazards potentially associated with the observed RHC and RBW patterns. The proposed approach is implemented as a systematic search, according to which alternative candidate locations are ranked based on the strength of association with the observed birth outcome patterns. For empirical validation, we apply this approach to the Haifa Bay Area (HBA) in Israel, which is characterized by multiple health hazards and numerous sources of air pollution. We identified a spot in the local industrial zone as the main risk source associated with the observed RHC and RBW patterns. Multivariate regressions, controlling for personal, neighborhood, and geographic factors, revealed that the relative risks of RHC and RBW tend to decline, other things being equal, as a function of distance from the identified industrial spot. We recommend the proposed identification approach as a preliminary risk assessment tool for environmental health studies, in which detailed information on specific sources of air pollution and air pollution dispersion patterns is unavailable due to limited reporting or insufficient monitoring.

Residential mobility of pregnant women and implications for assessment of spatially-varying environmental exposures

Health studies on spatially-varying exposures (e.g., air pollution) during pregnancy often estimate exposure using residence at birth, disregarding residential mobility. We investigated moving patterns in pregnant women (n = 10,116) in linked cohorts focused on Connecticut and Massachusetts, U.S., 1988-2008. Moving patterns were assessed by race/ethnicity, age, marital status, education, working status, population density, parity, income, and season of birth. In this population, 11.6% of women moved during pregnancy. Movers were more likely to be younger, unmarried, and living in urban areas with no previous children. Among movers, multiple moves were more likely for racial/ethnic minority, younger, less educated, unmarried, and lower income women. Most moves occurred later in pregnancy, with 87.4% of first moves in the second or third trimester, although not all cohort subjects enrolled in the first few weeks of pregnancy. Distance between first and second residence had a median value of 5.2 km (interquartile range 11.3 km, average 57.8 km, range 0.0-4277 km). Women moving larger distances were more likely to be white, older, married, and work during pregnancy. Findings indicate that residential mobility may impact studies of spatially-varying exposure during pregnancy and health and that subpopulations vary in probability of moving, and timing and distance of moves.

Residential mobility during pregnancy in Urban Gansu, China

BACKGROUND

Studies on environmental exposures during pregnancy commonly use maternal residence at time of delivery, which may result in exposure misclassification and biased estimates of exposure and disease association. Studies on residential mobility during pregnancy are needed in various populations to aid studies of the environmental exposure and birth outcomes. However, there is still a lack of studies investigating residential mobility patterns in Asian populations.

METHODS

We analyzed data from 10,542 pregnant women enrolled in a birth cohort study in Lanzhou, China (2010-2012), a major industrial city. Multivariate logistic regression was used to evaluate residential mobility patterns in relation to maternal complications and birth outcomes.

RESULTS

Of the participants, 546 (5.2%) moved during pregnancy; among those who moved, 40.5%, 34.8%, and 24.7% moved during the first, second, and third trimester, respectively. Most movers (97.3%) moved once with a mean distance of 3.75 km (range: 1-109 km). More than half (66.1%) of the movers moved within 3 km, 13.9% moved 3-10 km, and 20.0% moved > 10 km. Pregnant women who were > 30 years or multiparous, or who had maternal complications were less likely to have moved during pregnancy. In addition, movers were less likely to deliver infants with birth defects, preterm births, and low birth weight.

CONCLUSIONS

Residential mobility was significantly associated with several maternal characteristics and complications during pregnancy. The study also showed a lower likelihood of adverse birth outcomes among movers than non-movers, suggesting that moving might be related to reduce exposure to environmental hazards. These results confirm the hypothesis that residential mobility may be important with respect to exposure misclassification and that this misclassification may vary by subpopulations.

Shale gas development and infant health: Evidence from Pennsylvania

This research exploits the introduction of shale gas wells in Pennsylvania in response to growing controversy around the drilling method of hydraulic fracturing. Using detailed location data on maternal addresses and GIS coordinates of gas wells, this study examines singleton births to mothers residing close to a shale gas well from 2003 to 2010 in Pennsylvania. The introduction of drilling increased low birth weight and decreased term birth weight on average among mothers living within 2.5 km of a well compared to mothers living within 2.5 km of a permitted well. Adverse effects were also detected using measures such as small for gestational age and APGAR scores, while no effects on gestation periods were found. In the intensive margin, an additional well is associated with a 7 percent increase in low birth weight, a 5 g reduction in term birth weight and a 3 percent increase in premature birth. These results are robust to other measures of infant health, many changes in specification and falsification tests. These findings suggest that shale gas development poses significant risks to human health.

Environmental risk factors associated with low birth weight: The case study of the Haifa Bay Area in Israel

BACKGROUND

Low birth weight (LBW) is known to be associated with infant mortality and postnatal health complications. Previous studies revealed strong relationships between LBW rate and several socio-demographic factors, including ethnicity, maternal age, and family income. However, studies of association between LBW rate and environmental risk factors remain infrequent.

STUDY METHODS

We retrieved a geo-referenced data set, containing 7216 individual records of children born in 2015 in the Haifa Bay Area in Israel. Using this dataset, we analysed factors affecting LBW prevalence by applying two alternative techniques: analysis of LBW rates in small census area (SCAs) and more recently developed double kernel density (DKD) relative risk (RR) estimates.

RESULTS

In the SCA models, LBW rate was found to be associated with proximity to petrochemical industries (B=-0.26, 95%CI=-0.30, -0.22), road density (B=0.05, 95%CI=0.02, 0.08), distance to the seashore (B=0.17, 95%CI=0.14, 0.22), PM_2.5 (B=0.06, 95%CI=0.04, 0.09) and NO_x (B=0.10, 95%CI=0.06, 0.13) exposure estimates. Although similar factors emerged in the DKD models as well, in most cases, the effects of these factors in the latter models were found to be stronger: proximity to petrochemical industries (B=-0.48, 95%CI= -0.51, -0.30), road density (B=0.05, 95%CI=0.02, 0.08), distance to the seashore (B=0.24, 95%CI=0.21, 0.27), PM_2.5 (B=0.08, 95%CI=0.05, 0.10) and NO_x (B=0.20, 95%CI=0.17, 0.23) exposure estimates. In addition, elevation above the sea level was found to be statistically significant in spatial dependence models estimated for both DKD and SCA rates (P < 0.01).

CONCLUSION

The analysis revealed an excess LBW rate in residential areas located close to petrochemical industries and a protective effect of seashore proximity and elevation above the sea level on the LBW rate. We attribute the latter finding to the moderating effect of elevated seashore locations on outdoor temperatures during the hot summer season.

Mortality and morbidity in populations in the vicinity of coal mining: a systematic review

BACKGROUND

Evidence of the association of coal mining with health outcomes such as increased mortality and morbidity in the general population has been provided by epidemiological studies in the last 25 years. Given the diverse sources of data included to investigate different health outcomes in the exposed populations, the International Classification of Diseases (ICD) can be used as a single classification standard to compare the findings of studies conducted in different socioeconomic and geographic contexts. The ICD classifies diagnoses of diseases and other disorders as codes organized by categories and chapters.

OBJECTIVES

Identify the ICD codes found in studies of morbidity and/or mortality in populations resident or in proximity of coal mining and assess the methods of these studies conducting a systematic review.

METHODS

A systematic database search of PubMed, EMBASE and Scopus following the PRISMA protocol was conducted to assess epidemiological studies from 1990 to 2016. The health outcomes were mapped to ICD codes and classified by studies of morbidity and/or mortality, and the categories and chapters of the ICD.

RESULTS

Twenty-eight epidemiological studies with ecological design from the USA, Europe and China were included. The exposed populations had increased risk of mortality and/or morbidity by 78 ICD diagnosis categories and 9 groups of ICD categories in 10 chapters of the ICD: Neoplasms, diseases of the circulatory, respiratory and genitourinary systems, metabolic diseases, diseases of the eye and the skin, perinatal conditions, congenital and chromosomal abnormalities, and external causes of morbidity. Exposed populations had non-increased risk of 9 ICD diagnosis categories of diseases of the genitourinary system, and prostate cancer.

CONCLUSIONS

There is consistent evidence of the association of coal mining with a wide spectrum of diseases in populations resident or in proximity of the mining activities. The methods of the studies included in this review can be integrated with individual-level and longitudinal studies to provide further evidence of the exposure pathways linked to increased risk in the exposed populations.

Mapping outdoor habitat and abnormally small newborns to develop an ambient health hazard index

Background

The geography of where pregnant mothers live is important for understanding outdoor environmental habitat that may result in adverse birth outcomes. We investigated whether more babies were born small for gestational age or low birth weight at term to mothers living in environments with a higher accumulation of outdoor hazards.

Methods

Live singleton births from the Alberta Perinatal Health Program, 2006–2012, were classified according to birth outcome, and used in a double kernel density estimation to determine ratios of each outcome per total births. Individual and overlay indices of spatial models of 136 air emissions and 18 land variables were correlated with the small for gestational age and low birth weight at term, for the entire province and sub-provincially.

Results

There were 24 air substances and land sources correlated with both small for gestational age and low birth weight at term density ratios. On the provincial scale, there were 13 air substances and 2 land factors; sub-provincial analysis found 8 additional air substances and 1 land source.

Conclusion

This study used a combination of multiple outdoor variables over a large geographic area in an objective model, which may be repeated over time or in other study areas. The air substance-weighted index best identified where mothers having abnormally small newborns lived within areas of potential outdoor hazards. However, individual air substances and the weighted index provide complementary information.

Systematic review of community health impacts of mountaintop removal mining

BACKGROUND

The objective of this evaluation is to understand the human health impacts of mountaintop removal (MTR) mining, the major method of coal mining in and around Central Appalachia. MTR mining impacts the air, water, and soil and raises concerns about potential adverse health effects in neighboring communities; exposures associated with MTR mining include particulate matter (PM), polycyclic aromatic hydrocarbons (PAHs), metals, hydrogen sulfide, and other recognized harmful substances.

METHODS

A systematic review was conducted of published studies of MTR mining and community health, occupational studies of MTR mining, and any available animal and in vitro experimental studies investigating the effects of exposures to MTR-mining-related chemical mixtures. Six databases (Embase, PsycINFO, PubMed, Scopus, Toxline, and Web of Science) were searched with customized terms, and no restrictions on publication year or language, through October 27, 2016. The eligibility criteria included all human population studies and animal models of human health, direct and indirect measures of MTR-mining exposure, any health-related effect or change in physiological response, and any study design type. Risk of bias was assessed for observational and experimental studies using an approach developed by the National Toxicology Program (NTP) Office of Health Assessment and Translation (OHAT). To provide context for these health effects, a summary of the exposure literature is included that focuses on describing findings for outdoor air, indoor air, and drinking water.

RESULTS

From a literature search capturing 3088 studies, 33 human studies (29 community, four occupational), four experimental studies (two in rat, one in vitro and in mice, one in C. elegans), and 58 MTR mining exposure studies were identified. A number of health findings were reported in observational human studies, including cardiopulmonary effects, mortality, and birth defects. However, concerns for risk of bias were identified, especially with respect to exposure characterization, accounting for confounding variables (such as socioeconomic status), and methods used to assess health outcomes. Typically, exposure was assessed by proximity of residence or hospital to coal mining or production level at the county level. In addition, assessing the consistency of findings was challenging because separate publications likely included overlapping case and comparison groups. For example, 11 studies of mortality were conducted with most reporting higher rates associated with coal mining, but many of these relied on the same national datasets and were unable to consider individual-level contributors to mortality such as poor socioeconomic status or smoking. Two studies of adult rats reported impaired microvascular and cardiac mitochondrial function after intratracheal exposure to PM from MTR-mining sites. Exposures associated with MTR mining included reports of PM levels that sometimes exceeded Environmental Protection Agency (EPA) standards; higher levels of dust, trace metals, hydrogen sulfide gas; and a report of increased public drinking water violations.

DISCUSSION

This systematic review could not reach conclusions on community health effects of MTR mining because of the strong potential for bias in the current body of human literature. Improved characterization of exposures by future community health studies and further study of the effects of MTR mining chemical mixtures in experimental models will be critical to determining health risks of MTR mining to communities. Without such work, uncertainty will remain regarding the impact of these practices on the health of the people who breathe the air and drink the water affected by MTR mining.

Environmental and socio-economic determinants of infant mortality in Poland: an ecological study

BACKGROUND

Health status of infants is related to the general state of health of women of child-bearing age; however, women's occupational environment and socio-economic conditions also seem to play an important role. The aim of the present ecological study was to assess the relationship between occupational environment, industrial pollution, socio-economic status and infant mortality in Poland.

METHODS

Data on infant mortality and environmental and socio-economic characteristics for the 66 sub-regions of Poland for the years 2005-2011 were used in the analysis. Factor analysis was used to extract the most important factors explaining total variance among the 23 studied exposures. Generalized Estimating Equations model was used to evaluate the link between infant mortality and the studied extracted factors.

RESULTS

Marked variation for infant mortality and the characteristics of industrialization was observed among the 66 sub-regions of Poland. Four extracted factors: "poor working environment", "urbanization and employment in the service sector", "industrial pollution", "economic wealth" accounted for 77.3% of cumulative variance between the studied exposures. In the multivariate regression analysis, an increase in factor "poor working environment" of 1 SD was related to an increase in infant mortality of 40 (95% CI: 28-53) per 100,000 live births. Additionally, an increase in factor "industrial pollution" of 1 SD was associated with an increase in infant mortality of 16 (95% CI: 2-30) per 100,000 live births. The factors "urbanization and employment in the service sector" and "economic wealth" were not significantly related to infant mortality.

CONCLUSION

The study findings suggested that, at the population level, infant mortality was associated with an industrial environment. Strategies to improve working conditions and reduce industrial pollution might contribute to a reduction in infant mortality in Poland.

Environmental health impacts of unconventional natural gas development: a review of the current strength of evidence

Rapid global expansion of unconventional natural gas development (UNGD) raises environmental health concerns. Many studies present information on these concerns, yet the strength of epidemiological evidence remains tenuous. This paper is a review of the strength of evidence in scientific reporting of environmental hazards from UNGD activities associated with adverse human health outcomes. Studies were drawn from peer-reviewed and grey literature following a systematic search. Five databases were searched for studies published from January 1995 through March 2014 using key search terms relevant to environmental health. Studies were screened, ranked and then reviewed according to the strength of the evidence presented on adverse environmental health outcomes associated with UNGD. The initial searches yielded >1000 studies, but this was reduced to 109 relevant studies after the ranking process. Only seven studies were considered highly relevant based on strength of evidence. Articles spanned several relevant topics, but most focussed on impacts on typical environmental media, such as water and air, with much of the health impacts inferred rather than evidenced. Additionally, the majority of studies focussed on short-term, rather than long-term, health impacts, which is expected considering the timeframe of UNGD; therefore, very few studies examined health outcomes with longer latencies such as cancer or developmental outcomes. Current scientific evidence for UNGD that demonstrates associations between adverse health outcomes directly with environmental health hazards resulting from UNGD activities generally lacks methodological rigour. Importantly, however, there is also no evidence to rule out such health impacts. While the current evidence in the scientific research reporting leaves questions unanswered about the actual environmental health impacts, public health concerns remain intense. This is a clear gap in the scientific knowledge that requires urgent attention.

Adverse birth outcomes in the vicinity of industrial installations in Spain 2004-2008

Industrial activity is one of the main sources of ambient pollution in developed countries. However, research analyzing its effect on birth outcomes is inconclusive. We analyzed the association between proximity of mother's municipality of residence to industries from 24 different activity groups and risk of very (VPTB) and moderate (MPTB) preterm birth, very (VLBW) and moderate (MLBW) low birth weight, and small for gestational age (SGA) in Spain, 2004-2008. An ecological study was defined, and a "near vs. far" analysis (3.5 km threshold) was carried out using Hierarchical Bayesian models implemented via Integrated Nested Laplace Approximation. VPTB risk was higher for mothers living near pharmaceutical companies. Proximity to galvanization and hazardous waste management industries increased the risk of MPTB. Risk of VLBW was higher for mothers residing near pharmaceutical and non-hazardous or animal waste management industries. For MLBW many associations were found, being notable the proximity to mining, biocides and animal waste management plants. The strongest association for SGA was found with proximity to management animal waste plants. These results highlight the importance of further research on the relationship between proximity to industrial sites and the occurrence of adverse birth outcomes especially for the case of pharmaceutical and animal waste management activities.