Research Association between Residential Proximity to Fuel-Fired Power Plants and Hospitalization Rate for Respiratory Diseases Xiaopeng Liu,1 Lawrence Lessner,2 and David O. Carpenter 2 1Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing, China; 2Institute for Health and the Environment, University at Albany, State University of New York, Rensselaer, New York, USA Background : Air pollution is known to cause respiratory disease. Unlike motor vehicle sources, fuel-fired power plants are stationary. o Bjectiv : Using hospitalization data, we examined whether living near a fuel-fired power plant increases the likelihood of hospitalization for respiratory disease. Methods : Rates of hospitalization for asthma, acute respiratory infection (ARI), and chronic obstructive pulmonary disease (COPD) were estimated using hospitalization data for 1993–2008 from New York State in relation to data for residences near fuel-fired power plants. We also explored data for residential proximity to hazardous waste sites. r sulte : After adjusting for age, sex, race, median household income, and rural/urban residence, there were significant 11%, 15%, and 17% increases in estimated rates of hospitalization for asthma, ARI, and COPD, respectively, among individuals > 10 years of age living in a ZIP code containing a fuel- fired power plant compared with one that had no power plant. Living in a ZIP code with a fuel-fired power plant was not significantly associated with hospitalization for asthma or ARI among children < 10 years of age. Living in a ZIP code with a hazardous waste site was associated with hospitalization for all outcomes in both age groups, and joint effect estimates were approximately additive for living in a ZIP code that contained a fuel-fired power plant and a hazardous waste site. c onclusi : Our results are consistent with the hypothesis that exposure to air pollution from fuel-fired power plants and volatile compounds coming from hazardous waste sites increases the risk of hospitalization for respiratory diseases. k ey w ords : asthma, COPD, particulates, respiratory infection, SO2. Environ Health Perspect 120:807–810 (2012). http://dx.doi.org/10.1289/ehp.1104146 [Online 27 February 2012] Power plants provide electricity to satisfy a variety of needs of society. Some power plants, such as hydroelectric-, nuclear-, wind-, and solar-powered plants, provide energy without air pollution, but fuel-fired power plants are the major source of electrical power in most countries. Unfortunately, fuel-fired power plants emit millions of tons of air pollutants each year (Environmental Integrity Project 2007; Krewitt et al. 1998). In addition to for- mation and release of carbon dioxide, which is a major concern with regard to climate change, fuel-fired power plants release sulfur dioxide (SO2), nitrogen oxides (NOx), par- ticulate matter (PM), and polycyclic aromatic hydrocarbons (PAHs) and may also release volatile organic compounds (Schneider 2004). Although these air pollutants are also released by motor vehicles and other sources of fossil- fuel combustion, fossil-fuel power plants are localized sources of elevated air pollution. Air pollutant exposures are associated with increased risks of respiratory (Atkinson et al. 2001) and cardiovascular (Ito et al. 2011; Zanobetti and Schwartz 2005) diseases, and possibly also central nervous system diseases (Perera et al. 2008) and pregnancy complica- tions (O’Connor and Roy 2008). SO2 and NOx are known triggers for asthma attacks (Dales et al. 2006; Samoli et al. 2011) and increase risk for lung and heart disease (Jerrett et al. 2009; Wang et al. 2009). Smargiassi et al. (2009) investigated rates of asthmatic episodes in relation to short-term variations in SO2 levels coming from petroleum refiner- ies and found significant elevations in both emergency department visits and hospitaliza- tions. Ostro et al. (2009) reported daily rates of hospitalization of children for respiratory disease in relation to elevations in levels of air pollutants and found significantly ele- vated rates of hospitalization of 4.1% for PM ≤ 2.5 μm in aerodynamic diameter ( PM2.5), 3.4% for organic carbon, and 3.3% for NOx. PM coming from power plants may contain PAHs and heavy metals (O’Connor and Roy 2008; Yager et al. 1997), and these exposures may contribute to other adverse health effects, including cancer (Pope et al. 2002) and neu- rotoxic effects (Edwards et al. 2010). There is convincing evidence that exposure to air pollutants increases the risk of infectious respiratory disease. Chauhan and Johnston (2003) reviewed relationships between air pollution and respiratory infection and con- cluded that the association is strong and con- sistent, particularly for NOx. Children living in a community with high levels of PM with strong acidity (52 nmol/m3) were signifi- cantly more likely [odds ratio (OR) = 1.66; 95% confidence interval (CI): 1.11, 2.48] to report at least one episode of bronchitis in the past year compared with children living in the range of average city-specific air pollu- tion (31.1 nmol/m3). Elevated fine particulate sulfate (6.8 gμ/m 3) was associated with higher Environmental Health Perspectives • volume 120 | number 6 | June 2012 rates of bronchitis (OR = 1.65; 95% CI: 1.12, 2.42) than were concentrations of 4.7 gμ/m 3 (Dockery et al. 1996). Hermann et al. (2004) predicted that if 29 proposed fossil-fuel power plants in Virginia were operated for 6 years, PM2.5 in 272 counties would increase by > 0.01 gμ/m 3 and 104 additional premature deaths would occur. In a recent assessment, New York State was ranked third highest in incidence of adverse impacts attributable to power plant emissions (Schneider and Banks 2010). To our knowledge, no study has specifically doc- umented elevations in disease in relation to residential proximity to power plants. It is reasonable to assume that living near a fuel- fired power plant poses a risk of exposure to combustion products or byproducts, such as SO2, NOx, PM2.5, and PAHs, and that these contaminants will be inhaled and have adverse effects on health. The primary objective of this study was to assess the association of residential proximity to fuel-fired power plants with rates of hospital- ization for asthma and infectious and chronic respiratory diseases. In addition, we explored combined effects with residential proximity to hazardous waste sites, which has previously been associated with asthma and infectious respiratory disease hospitalization (Carpenter et al. 2008; Ma et al. 2007). Methods Study population. We used the New York Statewide Planning and Research Cooperative System (SPARCS) to obtain data on hospital discharges for the years 1993–2008. SPARCS is an administrative database maintained by the New York State Department of Health (NYSDOH; Albany, NY). For each inpatient upon discharge, every state-regulated hospital (except federal hospitals such as those operated by the Veterans Administration) must report Address correspondence to D.O. Carpenter, Institute for Health and the Environment, University at Albany–SUNY, 5 University Place, Rensselaer, NY 12144 USA. Telephone: (518) 525-2660. Fax: (518) 525-2665. E-mail: dcarpenter@albany.edu Supplemental Material is available online (http:// dx.doi.org/10.1289/ehp.1104146). X.L. was supported by a travel grant from Peking University. The study was supported by the Institute for Health and the Environment of the University at Albany. The authors declare that they have no actual or potential competing financial interests. Received 29 June 2011; Accepted 27 February 2012. 807