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Exposure to unconventional oil and gas development and all-cause mortality in Medicare beneficiaries

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Little is known about whether exposure to unconventional oil and gas development is associated with higher mortality risks in the elderly and whether related air pollutants are exposure pathways. We studied a cohort of 15,198,496 Medicare beneficiaries (136,215,059 person-years) in all major US unconventional exploration regions from 2001 to 2015. We gathered data from records of more than 2.5 million oil and gas wells. For each beneficiary’s ZIP code of residence and year in the cohort, we calculated a proximity-based and a downwind-based pollutant exposure. We analysed the data using two methods: a Cox proportional hazards model and a difference-in-differences design. We found evidence of a statistically significant higher mortality risk associated with living in proximity to and downwind of unconventional oil and gas wells. Our results suggest that primary air pollutants sourced from unconventional oil and gas exploration can be a major exposure pathway with adverse health effects in the elderly.

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Fig. 1: Process diagram of our study design.
Fig. 2: Map of the study area, which contains more than 120,000 active UOGD wells located in 9,244 ZIP codes as of December 2015.
Fig. 3: UOGD exposure assessment in an example ZIP code and month (Washington, Pennsylvania 15301, August 2015).
Fig. 4: The results of Model I and Model II in Analysis Set I.
Fig. 5: Trends in all-cause mortality rate in the treatment group and comparison group pre- and post-drilling.
Fig. 6: The results of a pre-test of the assumption of parallel trends in the mortality rate between the treatment and comparison groups (DiD in Analysis Set II).

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Data availability

Medicare beneficiary data are available from for researchers who meet the criteria for access to confidential data. UOGD data are available from Enverus ( via subscription. The UOGD exposure data that support the findings of this study are available from the corresponding author upon reasonable request.

Code availability

All model codes are available at


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This work was made possible by support from the US Environmental Protection Agency (EPA) grant RD-835872 (L.L., A.J.B., J.D.S., B.A.C., J.L., Y.W. and P.K.), the National Institutes of Health (NIH) grant R01 MD012769 (F.D.) and the Climate Change Solutions Fund at Harvard University (F.D.). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the US EPA, NIH or Harvard University. Furthermore, the US EPA does not endorse the purchase of any commercial products or services mentioned in the publication. We sincerely thank J. M. Wolfson, J. Buonocore and L. Goodwin for editing the manuscript.

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Authors and Affiliations



P.K. and L.L. initiated the study; L.L. synthesized data and performed research; L.L., B.A.C., J.D.S. and F.D. developed the model; and L.L., F.D., A.J.B., F.J.B.-S., Y.W. and P.K. wrote the manuscript. J.L. and J.D.S. helped interpret the results and provided comments.

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Correspondence to Longxiang Li.

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F.D. has served on the HEI Research Committee. The remaining authors declare no competing interests.

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Nature Energy thanks Seth B. C. Shonkoff, Michael Hendryx and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Supplementary Information

Supplementary Figs. 1–10, Notes 1–9 and Tables 1–6.

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Li, L., Dominici, F., Blomberg, A.J. et al. Exposure to unconventional oil and gas development and all-cause mortality in Medicare beneficiaries. Nat Energy 7, 177–185 (2022).

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