Factors influencing high respiratory mortality in coal-mining counties: a repeated cross-sectional study
| dc.contributor.author | Shi, Ruoding | en |
| dc.contributor.author | Meacham, Susan | en |
| dc.contributor.author | Davis, George C. | en |
| dc.contributor.author | You, Wen | en |
| dc.contributor.author | Sun, Yu | en |
| dc.contributor.author | Goessl, Cody | en |
| dc.contributor.department | Agricultural and Applied Economics | en |
| dc.date.accessioned | 2019-11-11T13:49:52Z | en |
| dc.date.available | 2019-11-11T13:49:52Z | en |
| dc.date.issued | 2019-11-08 | en |
| dc.date.updated | 2019-11-10T04:17:39Z | en |
| dc.description.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. | en |
| dc.description.version | Published version | en |
| dc.format.mimetype | application/pdf | en |
| dc.identifier.citation | BMC Public Health. 2019 Nov 08;19(1):1484 | en |
| dc.identifier.doi | https://doi.org/10.1186/s12889-019-7858-y | en |
| dc.identifier.uri | http://hdl.handle.net/10919/95475 | en |
| dc.language.iso | en | en |
| dc.rights | Creative Commons Attribution 4.0 International | en |
| dc.rights.holder | The Author(s) | en |
| dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | en |
| dc.title | Factors influencing high respiratory mortality in coal-mining counties: a repeated cross-sectional study | en |
| dc.title.serial | BMC Public Health | en |
| dc.type | Article - Refereed | en |
| dc.type.dcmitype | Text | en |