Coal ash ponds: Could they contribute to Alzheimer s disease risk in residential populations?

Transcription

1 Coal ash ponds: Could they contibute to Alzheime s disease isk in esidential populations? Julia Kavchenko, MD, PHD Assistant Pofesso, Depatment of Sugey, Duke Univesity School of Medicine Octobe 27-28, 2016 Muse Hotel, Duham, NC

2 Alzheime's disease is the most common cause of dementia a goup of bain disodes that cause the loss of inteectual and social skis. In Alzheime's disease, the bain ces degeneate and die, causing a steady decline in memoy and mental function. Scientists don t yet fuy undestand what causes Alzheime s disease. most people, Alzheime's disease is caused by a combination of genetic, lifestyle and envionmental factos that affect the bain ove time. Coss sections of the bain show atophy, o shinking, of bain tissue caused by Alzheime's disease.

3 Why should we woy about Alzheime s disease?

4 Age-adjusted motality ates of Alzheime s disease in the US, : - Based on undelying cause of death only (solid cuves), and - - based on the seconday causes of death as we (dashed cuves). (Souce: Akushevich, Kavchenko, et al, 2016)

5 Pecentage changes in selected causes of death in the U.S. between 2000 and 2013, a ages.

6 Pojected nbe of people with Alzheime s disease aged 65+ (total and fo thee age goups) in the U.S.: pojection up to 2050.

7 Age-adjusted death ates fo Alzheime s disease in the U.S., 2010.

8 Alzheime s disease death ates by counties, Noth Caolina, , pe 100,000. Cabaus 37.9 Cleveland 35.3 Davidson 35.1 Gaston 38.1 Ganvie 41.6 Matin 37.7 Mecklenbug 43.6 Mitche 41.1 Montgomey 42.8 Mooe 38.9 Robeson Rowan 45.9 Swain 40.2 Union 61.9 Yancey 37.9

9 NC counties with Alzheime s disease death ates ove 35 pe 100,000 The eason fo chonicay high Alzheime s motality ates in cetain egions within Noth Caolina is unclea.

10 Asenic and othe we wate issues often esult fom natuay occuing lage undegound slate tables such as the one in Union County. Union county (as does a lage pat of the Chalotte egion) sits diectly on top of a slate belt, which natuay poduces asenic in the goundwate.

11 The distibution of asenic concentations (ppb) in goundwate fom Noth Caolina. Asenic concentations above EPA MCL (10 ppb) ae maked as lage ed cicles (fom Vengosh et al., 2009). (Souce: Union County Community Health Assessment, 2008.)

12 Leading Poulty Poduction Counties in Noth Caolina. (Souce: Asenic-based dugs have been used in poulty poduction fo decades (Silbegeld, Nachman 2008) to teat coccidiosis (a common paasitic disease in poulty), to impove feed convesion (which aows poulty to gain weight faste), and to impove meat pigmentation (Nachman et al., 2013).

13 Coal plants in NC Souce:

14 Southeasten Coal Plants with Ash In 2011, the Southen Aiance fo Clean Enegy (SACE) joined the Southen Envionmental Law Cente (SELC), Appalachian Voices, and NC Consevation Netwok (NCCN) to aise public awaeness and compel utilities to clean up thei most dangeous impoundments. This esulted in the ceation of fo infomation and esouces on coal ash in the egion. We used thei catalog fo this peliminay study. (Souce: Unlike ai poution coming fom powe plant smokestacks, coal ash is cuently unegulated a the fedeal level. Coal plants hold coal ash in ponds o impoundments that can be located next to wateways and communities. Many impoundments have been found to be stuctuay inadequate and many have been found to be leaking toxins into gound and neaby suface wates.

15 Coal plants in NC EPA Coal Ash Dam Hazad Ratings: High hazad indicate that a dam failue is likely to cause loss of han life. Significant hazad indicates that failue is likely to cause significant economic loss, envionment damage, o damage to infastuctue. Low hazad indicates that failue would likely not esult in loss of han life and would only esult in low economic o envionment losses. In Noth Caolina, out of 14 coal plants: 7 ae ated by the EPA as highly hazadous, 6 ae ated as significantly hazadous, and 1 is ated as having low hazad. Also, a 14 coal plants in NC have additional concens such as: Unlined impoundments that can easily leak toxic poutants to neaby goundwate, ives, and lakes. Impoundments in poo condition: EPA engineeing inspections found these dams in poo physical condition, putting them at isk fo leaks and failues. Contamination: Citizen testing, state o utility epoting shows that impoundments that ae contaminating goundwate, suface wate, o suounding popety above and beyond the pemitted, legal poution.

16 Coal ash contains concentated amount of heavy metals, such as lead, mecuy, asenic, chomi, seleni, vanadi, adioisotopes, and othe. Mecuy Mecuy may have toxic effects on cental and peipheal nevous system (including cognitive and moto dysfunction). Mecuy is consideed by WHO to be one of the top ten chemicals of majo public health concen. Asenic Long-tem exposue to asenic also can be associated with neuotoxicity, including Alzheime s disease (Gong, O Byant, 2010; Ghaibzadeh, Hoseini, 2008).

17 Health effects of coal ash Coal ash was ecognized as a Goup I han cacinogen (based on occupational exposue studies) associated with inceased isk of cance of skin, lung, and uinay bladde. It has been epoted that living in a close poximity to coal ash ponds may be associated with highe isk of cance, heat disease, espiatoy disodes, and bith defects. Coal ash can affect han health: diectly (pedominantly though inhalation of contaminated ai, and also via dinking contaminated wate), and indiectly (though the food chain when consing contaminated agicultual poducts). The health effects of coal ash have been pedominantly studied using animal models and han ce lines, with only a few shottem epidemiological studies.

18 Ou peliminay study evaluated the health and medical cae issues of Noth Caolina esidents living nea coal ash ponds and impoundments. Data we used: Data on health chaacteistics of Noth Caolina esidents: The State Inpatient Database (H-CUP data on disease-specific hospital admissions), Motality statistics fom the Noth Caolina Cente fo Health Statistics, Data on envionmental factos: List of coal plants in NC with amount of total gaons of ash in coal ash ponds, thei locations, and EPA hazad ating. Data on co-factos that equie consideation fo ou analysis: Demogaphics (the U.S. Census Bueau). Socioeconomic chaacteistics (H-CUP datafiles and the U.S. Census Bueau). Adult smoking pevalence (the Behavioal Risk cto Suveiance System (BRFSS, CDC).

19 We analyzed the diffeences in health outcomes between esidential populations of study counties compaed to contol counties. We also detemined possible associations between total gaons of ash in coal ash ponds, the level of EPA hazad ating fo coal ash ponds, and epoted health outcomes. The analyses wee adjusted by the age, median household income (fou quatiles fo the state, fom the pooest to the wealthiest), and adult smoking pevalence fo age specific goups.

20 Results on Alzheime s disease Motality Motality ates fo Alzheime s disease (ICD-10 code G30) wee highe in study goup compaed to contol, fo age goup 65+ (p<0.0001). Motality ates wee highe with inceasing amount of gaons of coal ash in coal ash ponds: e.g., pe each Giga gaon of coal ash in ash pond, people living in this aea aged 65+ ae pojected to have 16.6% moe deaths due to Alzheime s disease. Also, motality fom Alzheime s disease was highe in study counties that have coal ash plants with highe EPA s hazad ating (p<0.0001).

21 Results on Alzheime s disease Hospital admissions Hospital admission ates wee highe in study goup compaed to contol goup, age-adjusted: ORs vaied fom 1.18 to 1.43 (p<0.001), depending of a yea. Hospital admission ates wee inceasing with inceasing amount of gaons of coal ash in coal ash ponds: e.g., pe each Giga gaon of coal ash in ash pond people living in this aea aged 65+ ae pojected to have 14.6% moe hospitalizations fo Alzheime s disease.

22 Can we distinguish between the souces? Fist: to pove the findings on Alzheime s isk on lage datasets. Next step of analysis: Add additional states and also analyze as co-factos and look whethe they have natual souces of asenic aound the coal ash ponds and whethe they have lage poulty poductions hee (Alabama, Geogia, Kentucky, Tennessee, etc.). In these states, check whethe amount of gaons of coal ash coelates with Alzheime s disease isk. Use Medicae data fo U.S.-wide analysis of geogaphic distibution of Alzheime s disease cases. Conside geogaphic distibution of othe potential souces of asenic. with coelations

23 Study team: The Cente fo Applied Theapeutics, Depatment of Sugey, Duke Univesity School of Medicine: H. Kim Lyely, Julia Kavchenko, Pankaj Agawal, Sung Han Rhew (post-doc) We thank Igo Akushevich (Associated Pofesso at SSRI, Duke Univesity) fo his help in analysis. We thank Fed and Alice Stanback fo suppoting this study with a philanthopic donation.

24 Appendix

25 Study design Study Goup: Counties with coal plants: County-specific analysis. Ou peliminay study is county-based. Zipcode level analysis is in pogess. Buncombe, Catawba, Chatham, Cleveland, Gaston, New Hanove, Peson, Robeson, Rockingham, Rowan, Stokes, Wayne. Total gaons of ash in these plants vaied fom 216,365,348 (Eden, NC) to as high as 4,123,323,977 (Walnut Cove, NC). Gaston and Peson counties have two coal plants pe each county. ou peliminay analysis we smaized the total gaons of ash pe each county. Contol goup. Two types of contol: the main contol goup included a NC counties that do not have coal plants listed at shoutheastcoalash.og; in addition, we used a moe stingent contol: we excluded counties that bode the counties with coal plants in NC o in the neighboing states.

26 Analysis Disease-specific motality ates in populations of study counties compaed to contol goup of counties, age goup specific. Univaiate analysis of association between disease-specific motality ates and total gaons of ash, age goup specific, foowed by multivaiate analysis afte adjusting fo smoking pevalence and median household income, age goup specific. Disease-specific motality ates fo EPA hazad atings, afte adjusting fo smoking pevalence and median household income, fo age specific goups Disease-specific hospital admission ates in study counties compaed to contol goup of counties, age adjusted. Univaiate analysis of association between disease-specific hospital admission ates and total gaons of ash, age goup specific, foowed by multivaiate analysis afte adjusting fo smoking pevalence and median household income, age goup specific. Note: only significant esults (p<0.05) ae shown in this pesentation.