Examination of Child and Adolescent Hospital Admission Rates in Queensland, Australia, 1995-2011: A Comparison of Coal Seam Gas, Coal Mining, and Rural Areas

Disadvantaged by More Than Distance: A Systematic Literature Review of Injury in Rural Australia

Rural populations experience injury-related mortality and morbidity rates 1.5 times greater than metropolitan residents. Motivated by a call for stronger epidemiological evidence around rural injuries to inform prevention, a systematic review of peer-reviewed literature published between January 2010 and March 2021 was undertaken to explore the epidemiology of rural injury and associated risk factors in Australia. A subsequent aim was to explore definitions of rurality used in injury prevention studies. There were 151 papers included in the review, utilizing 23 unique definitions to describe rurality. People living in rural areas were more likely to be injured, for injuries to be more severe, and for injuries to have greater resulting morbidity than people in metropolitan areas. The increase in severity reflects the mechanism of rural injury, with rural injury events more likely to involve a higher energy exchange. Risk-taking behavior and alcohol consumption were significant risk factors for rural injury, along with rural cluster demographics such as age, sex, high socio-economic disadvantage, and health-related comorbidities. As injury in rural populations is multifactorial and nonhomogeneous, a wide variety of evidence-based strategies are needed. This requires funding, political leadership for policy formation and development, and implementation of evidence-based prevention interventions.

Unconventional oil and gas development and health outcomes: A scoping review of the epidemiological research

BACKGROUND

Hydraulic fracturing together with directional and horizontal well drilling (unconventional oil and gas (UOG) development) has increased substantially over the last decade. UOG development is a complex process presenting many potential environmental health hazards, raising serious public concern.

AIM

To conduct a scoping review to assess what is known about the human health outcomes associated with exposure to UOG development.

METHODS

We performed a literature search in MEDLINE and SCOPUS for epidemiological studies of exposure to UOG development and verified human health outcomes published through August 15, 2019. For each eligible study we extracted data on the study design, study population, health outcomes, exposure assessment approach, statistical methodology, and potential confounders. We reviewed the articles based on categories of health outcomes.

RESULTS

We identified 806 published articles, most of which were published during the last three years. After screening, 40 peer-reviewed articles were selected for full text evaluation and of these, 29 articles met our inclusion criteria. Studies evaluated pregnancy outcomes, cancer incidence, hospitalizations, asthma exacerbations, sexually transmitted diseases, and injuries or mortality from traffic accidents. Our review found that 25 of the 29 studies reported at least one statistically significant association between the UOG exposure metric and an adverse health outcome. The most commonly studied endpoint was adverse birth outcomes, particularly preterm deliveries and low birth weight. Few studies evaluated the mediating pathways that may underpin these associations, highlighting a clear need for research on the potential exposure pathways and mechanisms underlying observed relationships.

CONCLUSIONS

This review highlights the heterogeneity among studies with respect to study design, outcome of interest, and exposure assessment methodology. Though replication in other populations is important, current research points to a growing body of evidence of health problems in communities living near UOG sites.

Air Quality in Association With Rural Coal Mining and Combustion in New South Wales Australia

PURPOSE

Rural areas may face under-recognized threats to air quality. We tested 2 hypotheses that 1) rural areas in New South Wales, Australia, would have better air quality than metropolitan Sydney, and that 2) the rural Upper Hunter region characterized by coal mining and coal combustion would have worse air quality than other rural areas of the state.

METHODS

We analyzed 2017 daily mean values for New South Wales, Australia, for particulate matter (PM2.5 and PM10), sulfur dioxide (SO₂ ), nitric oxide (NO), nitrogen dioxide (NO₂ ), and NOx (sum of NO and NO₂ ). Forty-six air monitoring stations were grouped into 6 rural and urban regional areas. Linear regression models examined pollution levels in association with rural and urban regions and meteorological covariates.

RESULTS

Findings show that daily mean pollutant levels in the rural Upper Hunter were the highest of all regions, and were significantly higher than metropolitan Sydney, with and without control for weather conditions, for every pollutant. For example, daily mean PM2.5 was 8.64 µg/m³ in the rural Upper Hunter, compared to 7.23 µg/m³ in metropolitan Sydney.

CONCLUSIONS

Results highlight the need to consider both urban and rural sources of pollution in air quality studies, and appropriate policy steps to address likely rural air pollution from coal mining.

Is Increasing Coal Seam Gas Well Development Activity Associated with Increasing Hospitalisation Rates in Queensland, Australia? An Exploratory Analysis 1995-2011

The majority of Australia's coal seam gas (CSG) reserves are in Queensland, where the industry has expanded rapidly in recent years. Despite concerns, health data have not been examined alongside CSG development. This study examined hospitalisation rates as a function of CSG development activity in Queensland, during the period 1995-2011. Admissions data were examined with CSG well numbers, which served as a proxy for CSG development activity. Time series models were used to assess changes in hospitalisation rates for periods of "low", "medium", "high", and "intense" activity compared to a period of "very low" activity, adjusting for covariates. "All-cause" hospitalisation rates increased monotonically with increasing gas well development activity in females (324.0 to 390.3 per 1000 persons) and males (294.2 to 335.4 per 1000 persons). Hospitalisation rates for "Blood/immune" conditions generally increased for both sexes. Female and male hospitalisation rates for "Circulatory" conditions decreased with increasing CSG activity. Hospitalisation rates were generally low for reproductive and birth outcomes; no clear associations were observed. This study showed some outcomes were associated with increasing CSG development activity. However, as a condition of data access, the population and outcomes were aggregated to a broad geographic study area rather than using higher geographic resolution data. Higher resolution data, as well as other data sources, should be explored. Further research should be conducted with an expanded time period to determine if these trends continue as the industry grows.