linking the burden of amls to community health

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WBSR Symposium IVAMLs and Health

Brian Schwartz & Ann Liu

Linking the Burden of AMLsto Community Health

Brian S. Schwartz, MD, MSAnn Liu, MPH

July 18, 2008

West Branch Susquehanna Restoration Symposium IV

Overview• How can places affect human health?• Summary of current status of our

ongoing study– Overview and data sources

– Ecologic study: preliminary results of association of selected measures of burden of AMLs in places with selected “community health” outcomes

• Future plans

Brian

Ann

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Anthracite regionBituminous region

AML Areas in Pennsylvania by Coal Type

From RAMLIS database – AML inventory system

How Do We Figure Out If Those Places Are A

Threat To Public Health?

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AML Impacted Community, Anthracite Region: Swoyersville, Luzerne Co., PA

Aerial photo source: USDA 2004 (~ 1:10,000 Scale). Slide courtesy of John Dawes.

How Could AMLs Influence Human Health?

• Traditional environmental health approach: agents, sources, & routes of exposure– Is the “stuff” left behind by AMLs toxic?

• What is the toxicity?– Does that stuff get into the air?

• Does that air get into people?– Does that stuff get into the water? Surface or

ground?• Does that water get into people?

– Is any of that stuff toxic at the levels that get into people?

• The importance of dose

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How About Through The Influence of PLACE?

• Do places influence health (separate from the stuff that comes off of them)?

• Growing scientific literature on the influence of neighborhoods on health– Even after controlling for the aspects of

individuals in those places, places can have an additional impact on health

• These neighborhood factors could operate through “stress” pathways, could change behaviors, or through other mechanisms

Compositional and Contextual Effects(Adapted from L Musewe, University of Pittsburgh)

• Observe spatial variation in health: Ask – what is it due to?• Compositional interpretation: individual characteristics are most important; similar people have similar health, no matter where they live.• But, this may result in the atomistic fallacy – effects that are understood better at household, neighborhood, or regional level are overlooked. • Contextual effects operate where the health experience of an individual depends partly on the social and physical environment in the area where s/he lives.• Causes people with similar individual attributes to have different health status in different contexts.

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AMLs Health• Traditional EH approach – the parts of

AMLs that result in hazardous exposures(agents, sources, routes)

• AMLs as BUILT environment – how the human-altered environment influences behaviors

• AMLs as SOCIAL environment – complex interactions among people & with society– Several biologic pathways may be operating

compositional

contextual - place

contextual - group

So, we have a large state, with many abandoned mines

and people living among them.

What to do now?

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Specific Aims – First Phase• Characterize the burden that AMLs leave

behind, in four sentinel dimensions, using geographic information systems (GIS)

• Determine the associations of these measures of the burden of AMLs with community health in an ecologic study

• Generate evidence for accelerating AML reclamation and facilitating the prioritization of specific sites for reclamation efforts using a public healthframework

Data Sources

• RAMLIS database: for AML features– RAMLIS = Reclaimed Abandoned Mine

Land Inventory System

• US Census: for community health

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Methods: Assessment of AML Burden• Burden of AML is our independent variable• Using GIS geo-processing, create

summary metrics for the burden of AMLsin Census tracts– 32 mine features (e.g., shafts, mine drainage,

high walls, refuse piles, structures)– 6 dimensions (e.g., number, area, height,

length, volume, flow)– For each of reclaimed and non-reclaimed

mines– Thus up to 384 possible variables– Data reduction was necessary

Numbers* For Selected Features

191684Subsidence prone area291680Abandoned structures2384272AMD discharge area

164010,011Dry strip mine2811320Flooded strip mine2825887Spoil pile3671075Vertical mine shaft171765Abandoned refuse pile24383Untreated deep mine discharge43141Underground mine fire

5162231Open shaftReclaimedUnreclaimedFeature

* Numbers of points or polygons in RAMLIS

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Methods: Assessment of Community Health

• Community health is our dependent variable

• Using Census 2000 data aggregated in tracts

• Will create scales by combining variables in categories (sentinel dimensions)

• Three sentinel dimensions of community health will be created

1) Townsend Index of Deprivation (% unemployment, % households overcrowded, % renter-occupied housing, % households without car); 2) % adults without HS diploma; 3) % families in poverty; 4) % households in poverty; 5) % on public assistance; 6) % working class

Economic deprivation

1) % vacant housing; 2) % no indoor plumbing; 3) % no water; 4) % no kitchen

Physical disorder

1) % single parent families with kids; 2) % divorced or separated; 3) % out of labor force; 4) 1 - % home owner occupied; 5) 1 - % living in same household last 5 years

Social disorgani-zation

Three Dimensions of Community Health

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A look at some of

the data

Let’s ask Ann …

Population Density

This is where the people are. Epidemiologists care about the people.

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AML Areas

This is where the abandoned mines are.

Count data

794 of these have at least one AML

3,135 census tracts in PA

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Sample census tract with AML features

Population center

How do we create health-relevant measures from mine features?

Measured at the Place Level• From the urban design and landscape

architecture literatures• Density – of households, jobs,

“things” per geographic area• Accessibility – nearest neighbor,

cumulative opportunity, gravity models

• Diversity – in land use; land use mix; balance, dissimilarity of hazards

• Clustering – a pattern of spatial distribution, the location of points relative to others

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Examples• Density

– # open mine shafts / area of census tract– # AMD discharge areas / census tract

population– # spoil piles / area or population– Total AML area / area of census tract

• Accessibility– Average distance of each open mine shaft to

census tract population center– Average distance of each spoil pile to census

tract population center• Diversity

– The average number of different features per AML site / area of census tract

1) Density of these; 2) Accessibility to these; 3) Total area of reclaimed dry strip mines

Reclaimed features

1) Density of AMD discharge areas; 2) Accessibility to AMD discharge areas; 3) Density of AMD impacted streams; 4) Accessibility to AMD impacted streams

Toxic contami-nation

1) Density of dry strip mines; 2) Accessibility to dry strip mines; 3) Density of spoil piles; 4) Accessibility to spoil piles; 5) Density of refuse piles; 6) Accessibility to refuse piles

Aesthetic quality

1) Density of open mine shafts; 2) Accessibility to open mine shafts; 3) Density of subsidence prone areas; 4) Density of flooded strip mines; 5) Density of vertical mine shafts; 6) Accessibility to vertical mine shafts

Physical hazards

Four Metrics for Assessing Burden of Abandoned Mines in Places

Note: Method for diversity of AML features TBD

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Density per area350 census tracts

have at least one dry strip mine

Density per area334 census tracts

have at least one open mine shaft

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Data Analysis

• First, evaluate correlations between AML metrics and community health metrics

• Second, use linear regression to control for potential confounding variables:– Age structure of population

– Possibly others

Preliminary Results

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• Density of open mine shafts per area (SHAFTDENS)

• Density of dry strip mines per area (STRIPDENS)

• Median housing value in owner-occupied housing (HOUSEVAL)

• Percent divorced or separated (DIVORCED)

• Percent vacant housing (HOUSEVAC)

Exploring Some Selected Variables

As Density of Strip Mines or Open Shafts Goes Up, House Values Go Down,

Divorce Rates Go Up

r = 0.07p = 0.17

r = -0.17p = 0.002

r = -0.22p < 0.001

r = -0.03p = 0.56

r = 0.11p = 0.04

r = -0.24p < 0.001

r = -0.09p = 0.08

r = 0.10p = 0.08

r = -0.11p = 0.04

r = 0.43p < 0.001SHAFTDENS

STRIPDENS

HOUSEVAL

DIVORCED

SHAFTDENS

STRIPDENS

HOUSEVAL

DIVOR-CED

HOUSEVAC

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Second Phase

(Within Two Years?!?)

Evaluation of Associations of AML in Places with Health of

Individuals

Place = Census tract

Burden of AML

Community health

MULTILEVEL Analysis of Associations of AML Measures with Individual Health

Individual health

Place level Individual level

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Health Outcomes We Are Considering –Will Obtain Data on Patients From Geisinger Electronic Health Record

• Cancer• Coronary artery disease• Hypertension• Birth defects• Other adverse pregnancy outcomes (e.g.,

preterm delivery, low birth weight)• Mental health (e.g., anxiety disorders,

depression)

Please feel free to contact us

Brian Schwartz: [email protected]

Ann Liu:[email protected]

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Questions?

linking the burden of amls to community health

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