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BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Research article

Factors influencing high respiratory mortality in coal-mining counties: a repeated cross-sectional study

Authors: Ruoding Shi, Susan Meacham, George C. Davis, Wen You, Yu Sun, Cody Goessl

Published in: BMC Public Health | Issue 1/2019

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Abstract

Background

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. 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.

Methods

An 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.

Results

The 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.

Conclusions

This 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.
Appendix
Available only for authorised users
Footnotes
1
Several previous studies identified elevated mortality rates in coal-mining areas but did not name their findings as “coal-county effects.
 
2
Health behavioral risk factors refer to risk behaviors that lead to poor health outcomes.
 
3
1 Counties in the metropolitan area: Rural-Urban Continuum codes 1–3 with the description of “Metro - Counties in metro areas”;
2) Non-metropolitan urban counties: Rural-Urban Continuum codes 4–7 with the description of “Nonmetro - Urban population of 2500 or more”;
3) Rural counties: Rural-Urban Continuum codes 8–9 with the description of “Nonmetro county completely rural or less than 2500 urban population.
 
4
In addition to 21 counties, there are three independent cities: Bristol City and Norton City in the coal region and Danville City in the tobacco region. So we have a total of 24 clusters.
 
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Metadata
Title
Factors influencing high respiratory mortality in coal-mining counties: a repeated cross-sectional study
Authors
Ruoding Shi
Susan Meacham
George C. Davis
Wen You
Yu Sun
Cody Goessl
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7858-y

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