Mortality Rates in Appalachian Coal Mining Counties: 24 Years Behind the Nation

Appalachia has higher morbidity and mortality compared to the nation, and suffers greater socioeconomic disadvantages. This article investigates the relationship of coal mining to elevated mortality rates in Appalachia. Total mortality rates for the years 1999–2004 were investigated in a national county-level analysis that included coal mining as the primary independent variable. Counties in Appalachia where coal mining is heaviest had significantly higher age-adjusted mortality compared to other Appalachian counties and to other areas of the country. Elevated mortality rates persisted in Appalachian coal mining areas after further statistical adjustment for smoking, poverty, education, rural-urban setting, race/ethnicity, and other variables. After adjustment for all covariates, Appalachian coal mining areas were characterized by 1,607 excess annual deaths over the period 1999–2004. Adjusted mortality rates increase with increasing coal production from 1 to 7 million tons. These findings highlight environmental inequities that persist in Appalachian coal mining areas. Reducing these inequities will require development of alternative economies and promotion of environmental justice through regulatory and allocative policy changes. 5 APPALACHIA HAS LONG been characterized by social inequalities and health disparities.1–4 Recently, the contributions that the coal mining industry makes to these inequalities and disparities has come under closer attention. Coal mining areas are linked to higher population hospitalization rates for some cardiovascular and respiratory conditions,5 and to higher reported rates of some forms of chronic illness and poorer reported health status.6 Compared to other parts of Appalachia, coal mining areas are also characterized by poor socioeconomic conditions including higher levels of poverty and lower education rates.7 The purpose of the current study was to extend prior research on the community health impacts of the Appalachian coal mining industry through an examination of mortality rates. The study tests whether mortality rates are elevated in Appalachian coal mining areas, and whether elevated mortality, if found, is due solely to socioeconomic conditions or if an additional effect specific to coal mining persists. The study also examines temporal trends in mortality in coal mining areas. Three hypotheses are tested: 1. Coal mining areas of Appalachia will be associated with higher total mortality rates compared to the rest of Appalachia and the nation, both before and after adjustment for socioeconomic covariates. 2. Mortality rates will be higher in Appalachia compared to the nation, but these rates will not remain elevated after controlling for socioeconomic effects. 3. Elevated mortality in Appalachian coal mining areas will be present over the time period 1979 to 2004.