Flaring from Unconventional Oil and Gas Development and Birth Outcomes in the Eagle Ford Shale in South Texas.

BACKGROUND: Prior studies suggest exposure to oil and gas development (OGD) adversely affects birth outcomes, but no studies have examined flaring-the open combustion of natural gas-from OGD. OBJECTIVES: We investigated whether residential proximity to flaring from OGD was associated with shorter gestation and reduced fetal growth in the Eagle Ford Shale of south Texas. METHODS: We conducted a retrospective cohort study using administrative birth records from 2012 to 2015 (N=23,487) and satellite observations of flaring activity during pregnancy within 5km of maternal residence. Multivariate logistic and linear regression models were used to estimate associations between four outcomes (preterm birth, small-for-gestational age, continuous gestational age, and term birthweight) and exposure to a low (1-9) or high (≥10) number of nightly flare events, as compared with no exposure, while controlling for known maternal risk factors. We also examined associations with the number of oil and gas wells within 5km using data from DrillingInfo (now Enverus). RESULTS: Exposure to a high number of nightly flare events was associated with a 50% higher odds of preterm birth [odds ratio (OR)=1.50 (95% CI: 1.23, 1.83)] and shorter gestation [mean difference=-1.9 (95% CI: -2.8, -0.9) d] compared with no exposure. Effect estimates were slightly reduced after adjustment for the number of wells within 5km. In stratified models these associations were present only among Hispanic women. Flaring and fetal growth outcomes were not significantly associated. Women exposed to a high number of wells (fourth quartile, ≥27) vs. no wells within 5km had a higher odds of preterm birth [OR=1.31 (95% CI: 1.14, 1.49)], shorter gestation [-1.3 (95% CI: -1.9, -0.8) d], and lower average birthweight [-19.4 (95% CI: -36.7, -2.0) g]. DISCUSSION: Our study suggests exposure to flaring from OGD is associated with an increased risk of preterm birth. Our findings need to be confirmed in other populations. https://doi.org/10.1289/EHP6394.

Life expectancy in pancreatic neuroendocrine cancer.

BACKGROUND: The prognoses widely reported for pancreatic cancer reflect the very poor survival associated with the most common histological type, exocrine adenocarcinoma. We calculated life expectancies for patients with less common pancreatic neuroendocrine tumors (PNETs), and also for the subsets of these patients who survive 1 and 5 years post-diagnosis, all of which carry a significantly better prognosis. Results for 1- and 5-year PNET survivors appear not to have been previously reported, nor have life expectancies (average long-term survival times) been given. METHODS: We identified 5287 cases of PNET in the SEER US national database, 1973-2013. The Kaplan-Meier estimator was used to compute empirical survival probabilities and median survival times for functioning (n = 279) and non-functioning PNET (n = 5008) cases. The Cox proportional hazards regression model was used to examine univariate associations of survival with covariates including patient age, sex, race, cancer stage, tumor grade, surgical treatment, and calendar year. A multivariate multiplicative hazard Poisson regression model estimated mortality rates for all combinations of the covariates. The rates were used to construct actuarial life tables, which gave life expectancies for male and female patients according to age, cancer stage, tumor grade, histology (functioning versus non-functioning), surgical treatment status, and time since diagnosis. These life expectancies were compared with age- and sex-specific figures from the US general population. RESULTS: Life expectancy in PNET is lower than that of the US general population and varies significantly according to patient age, cancer stage, tumor grade, mode of treatment, and time since diagnosis. For example, it is near normal for persons aged 70 and older who undergo surgical resection of localized well-differentiated (i.e., grade I) tumors. By contrast, persons with metastatic high-grade tumors not amenable to surgery have life expectancies of only 1 to 4 years depending on patient age. Functioning PNETs were associated with somewhat lower mortality than non-functioning within the first few years after diagnosis, though no major differences were observed long-term. Positive factors for survival were younger age, localized stage, low tumor grade, and surgical treatment. Survival improved over the 1973-2013 study period: on average mortality rates fell by 1.2% per year after controlling for changes in the patient population. Life expectancy increased markedly with time since diagnosis: those surviving 1 and 5 years post-diagnosis had longer additional life expectancies. CONCLUSIONS: Life expectancies of patients with PNETs may be markedly reduced from normal, but even in the worst cases their prognoses remain significantly better than that of patients with the more common pancreatic adenocarcinomas. In some very favorable cases, the life expectancy is near-normal, especially amongst 1- and 5-year survivors. This information can be used to counsel patients.

Life Expectancy in Pleural and Peritoneal Mesothelioma.

Background. Mesothelioma is a rare cancer with a historically dire prognosis. We sought to calculate life expectancies for patients with pleural or peritoneal mesothelioma, both at time of diagnosis and several years later, and to examine whether survival has improved in recent years. Methods. Data on 10,258 pleural and 1,229 peritoneal patients from the SEER US national cancer database, 1973-2011, were analyzed using the Cox proportional hazards regression model. Results. The major factors related to survival were age, sex, stage, grade, histology, and treatment. Survival improved only modestly over the study period: 0.5% per year for pleural and 2% for peritoneal. Conclusions. Life expectancies were markedly reduced from normal, even amongst 5-year survivors with the most favorable characteristics and treatment options.