Abstract
BackgroundPrevious studies have associated elevated mortality risk in central Appalachia with coal-mining activities, but few have explored how different non-coal factors influence the association within each county. Consequently, there is a knowledge gap in identifying effective ways to address health disparities in coal-mining counties. To specifically address this knowledge gap, this study estimated the effect of living in a coal-mining county on non-malignant respiratory diseases (NMRD) mortality, and defined this as “coal-county effect.” We also investigated what factors may accentuate or attenuate the coal-county effect.MethodsAn ecological epidemiology protocol was designed to observe the characteristics of three populations and to identify the effects of coal-mining on community health. Records for seven coal-mining counties (n = 19,692) were obtained with approvals from the Virginia Department of Health Office of Vital Statistics for the years 2005 to 2012. Also requested were records from three adjacent coal counties (n = 10,425) to provide a geographic comparison. For a baseline comparison, records were requested for eleven tobacco-producing counties (n = 27,800). We analyzed the association of 57,917 individual mortality records in Virginia with coal-mining county residency, county-level socioeconomic status, health access, behavioral risk factors, and coal production. The development of a two-level hierarchical model allowed the coal-county effect to vary by county-level characteristics. Wald tests detected sets of significant factors explaining the variation of impacts across counties. Furthermore, to illustrate how the model estimations help explain health disparities, two coal-mining county case studies were presented.ResultsThe main result revealed that coal-mining county residency increased the probability of dying from NMRD. The coal-county effect was accentuated by surface coal mining, high smoking rates, decreasing health insurance coverage, and a shortage of doctors. In Virginia coal-mining regions, the average coal-county effect increased by 147% (p-value< 0.01) when one doctor per 1000 left, and the effect increased by 68% (p-value< 0.01) with a 1% reduction of health insurance rates, holding other factors fixed.ConclusionsThis study showed a high mortality risk of NMRD associated with residents living in Virginia coal-mining counties. Our results also revealed the critical role of health access in reducing health disparities related to coal exposure.
Highlights
Previous studies have associated elevated mortality risk in central Appalachia with coal-mining activities, but few have explored how different non-coal factors influence the association within each county
This study is a step forward in understanding the underlying factors that may be associated with a “coal-county effect” and helps identify factors that can be targeted to improve health in coal-mining counties
We found a higher risk of dying from non-malignant respiratory diseases (NMRD) associated with living in a coal-mining county, but not with living in an adjacent county
Summary
Previous studies have associated elevated mortality risk in central Appalachia with coal-mining activities, but few have explored how different non-coal factors influence the association within each county. There is a knowledge gap in identifying effective ways to address health disparities in coal-mining counties To address this knowledge gap, this study estimated the effect of living in a coal-mining county on non-malignant respiratory diseases (NMRD) mortality, and defined this as “coal-county effect.”. Mining releases a large amount of coal dust and methane into the environment and results in higher concentrations of particulate matter and sulfate, impairing coal miner’s respiratory system, a condition known as coal workers’ pneumoconiosis (CWP) [9] Another coal-related lung disease is silicosis caused by inhalation of crystalline silica dust. The potential health effects of environmental contaminants produced by coal mining on community residents are the subject of ongoing investigations [10]
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