燃煤电厂排放物对健康影响的源导向研究
A Source-Oriented Approach to Coal Power Plant Emissions Health Effects
摘要：
人们越来越关注不同来源的空气污染是否对健康有不同的影响。特别是，最近的证据表明，细颗粒物（PM2.5）与化学示踪剂表明煤炭燃烧的起源是特别有害的。通过因果推断方法的估计来增加这一知识，以确定来自特定燃煤点源的PM2.5对健康的影响，将是为具体的、有针对性的干预措施提供信息的重要一步。我们调查了783个燃煤发电机组的燃煤排放对居住在美国东部21，351个邮政编码的1900多万医疗保险受益人缺血性心脏病（IHD）住院的影响。我们使用InMAP，一种新开发的，降低复杂性的空气质量模型，将每个邮政编码分类为高暴露或控制位置。我们的健康结果分析使用了一种因果推断方法--倾向得分匹配--来调整暴露与IHD之间关系的潜在混杂因素。我们拟合独立的泊松回归模型，以匹配数据在每个地理区域，以估计发病率比IHD比较高暴露于控制位置。在东北部（IRR = 1.08，95%CI = 1.06，1.09）和东南部（IRR = 1.06，95%CI = 1.04，1.08），高暴露于燃煤电厂排放和IHD呈正相关。在中西部工业区未发现显著相关性（IRR = 1.02，95% CI = 1.00，1.04），可能是该地区高暴露和对照邮政编码之间暴露对比较小的结果。这项研究提供了有针对性的证据，证明特定燃煤电厂的排放量与医疗保险受益人的IHD住院率之间存在关联。
英文摘要：
There is increasing focus on whether air pollution originating from different sources has different health implications. In particular, recent evidence suggests that fine particulate matter (PM2.5) with chemical tracers suggesting coal combustion origins is especially harmful. Augmenting this knowledge with estimates from causal inference methods to identify the health impacts of PM2.5 derived from specific point sources of coal combustion would be an important step towards informing specific, targeted interventions. We investigated the effect of high-exposure to coal combustion emissions from 783 coal-fired power generating units on ischemic heart disease (IHD) hospitalizations in over 19 million Medicare beneficiaries residing at 21,351 ZIP codes in the eastern United States. We used InMAP, a newly-developed, reduced-complexity air quality model to classify each ZIP code as either a high-exposed or control location. Our health outcomes analysis uses a causal inference method - propensity score matching - to adjust for potential confounders of the relationship between exposure and IHD. We fit separate Poisson regression models to the matched data in each geographic region to estimate the incidence rate ratio for IHD comparing high-exposed to control locations. High exposure to coal power plant emissions and IHD were positively associated in the Northeast (IRR = 1.08, 95% CI = 1.06, 1.09) and the Southeast (IRR = 1.06, 95% CI = 1.04, 1.08). No significant association was found in the Industrial Midwest (IRR = 1.02, 95% CI = 1.00, 1.04), likely the result of small exposure contrasts between high-exposed and control ZIP codes in that region. This study provides targeted evidence of the association between emissions from specific coal power plants and IHD hospitalizations among Medicare beneficiaries.
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