Zooming in on adverse birth outcomes in coalfield regions of Central Appalachia

Health disparities account for significant differences in mortality and morbidity risks in Central Appalachia (encompassing parts of WV, KY, TN and VA) compared to other U.S. regions, yet research addressing environmental factors potentially contributing to these health disparities is lacking. Central Appalachia offers a unique opportunity to examine environmental exposures associated with resource extraction. Coal production from large surface mines was the dominant resource extraction method in the 1990s-2000s and is now decreasing as other resource extraction methods increase. We hypothesize that health risks associated with air and water pollution exposure are greater for Central Appalachian residents living within close proximity to active surface mines. The results described here begins to link exposure with health outcomes using individual-level birth record data. We have extended spatiotemporal characterization of boundaries associated with surface mining between 1990 and 2015 in all Central Appalachia counties. Results indicate that from 1990 to 2015, 1806 km2 of land across the study area was disturbed by mining activities, which equates to approximately 4.2% of the study-defined Central Appalachia region. Temporal trends show a decreasing amount of active surface mining sites over the study period. Using a previously developed surface mining dataset that only covered southwest Virginia coalfields, we tested the hypothesis that maternal address proximity to active surface mining was positively associated with preterm birth. No significant association was found; however the sample size (n=5008) was very small due to poor geocoding rates, particularly in earlier years, and overall low number of births between 1990-2015 in this small, rural area (n=14,269). Our next steps will be to improve inference and precision in effect estimates by increasing sample size with inclusion of data from TN, KY and WV, application of the accuracy–assessed surface mining extent dataset described here to improve estimate of proximity to active surface mining, and inclusion of watershed boundaries, drinking water violation datasets, as well as airshed characterization. Ultimately, we hope this research will aid in determining the underpinnings of health disparities in Central Appalachian communities, ultimately leading to research, policy and practice improvements that may be generalizable to other rural areas beyond Central Appalachia.