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Relations between Health Indicators and Residential Proximity to Coal Mining in West Virginia The following information was printed in the American Journal of Public Health, Volume 98, Number 4, dated April 1, 2008. The authors are Michael Hendryx and Melissa Ahern. Opening Statement: We used data from a survey of 16,493 West Virginians merged with county-level coal production and other covariates to investigate the relations between health indicators and residential proximity to coal mining. Results of hierarchical analyses indicated that high levels of coal production were associated with worse adjusted health status and with higher rates of cardiopulmonary disease, chronic obstructive pulmonary disease, hypertension, lung disease and kidney disease. The United States has 27% of known coal reserves and as many as 153 new coal-fired power plants are scheduled for operation by 2030. Pressure to increase coal mining is likely to intensify because of concerns about nuclear power, energy security and peak global oil production. Increased coal demand may exacerbate negative health effects of coal-mining activities, including occupational hazards of coal mining, air pollution from burning coal, health consequences of carbon dioxide-caused climate change and community exposure to mining activities. We examined whether coal mining in West Virginia is related to poorer health status and incidence of chronic illness. We sought to find whether coal mining effects may result only from socioeconomic correlates of mining such as income or education or whether effects persist after controlling for such factors which would suggest possible environmental exposure problems. Methods: In 2001, the West Virginia University Institute for Health Policy Research conducted a telephone survey of adults 19 years and older. The response rate was 55%. We used 2000 U.S. Census date to weight survey respondents to match the age, gender, income, education and insurance status demographics of the State. Dependent variables included self reported health (scored 1="excellent" to 6="very poor") and the presence or absence of specific chronic health conditions. We obtained 2001 coal production figures from the West Virginia Geological and Economic Survey, including the short tons of coal mined from each county in both underground and surface mines. Coal production was not normally distributed so we divided county coal production into 3 dummy variables: (1) no production, (2) up to 3.9 million tons, and (3) 4.0 million tons or greater. County level covariates included smoking and obesity rates from the West Virginia Department of Health and Human Resources, percentage of the population below the poverty level from US census date, and a measure of social capital. Person-level covariates included age, gender, income, education and presence or absence of health insurance. Results: As coal production increased, health status worsened, and rates of cardiopulmonary disease, lung disease, cardiovascular disease, diabetes and kidney disease increased. Within larger disease categories, specific types of disease associated with coal production include chronic obstructive pulmonary disease (COPD), black lung disease and hypertension. We considered the possibility that results reflected current or former miners lining in the area. Almost all coal miners are men. the finding for black lung disease likely reflects a miner's effect, supported by the result that women are at lower risk. The only other illness for which men as a group had higher risk was the general cardiopulmonary category. We conducted an additional multilevel model separately for women for this category; the effects of the coal production variable remained significant. Discussion; Among West Virginia adults, residential proximity to heavy coal production was associated with poorer health status and with higher risk for cardiopulmonary disease, chronic lung disease, hypertension and kidney disease after we controlled for covariates. For illnesses that were associated with coal effects, the literature supports the hypothesis that the risk for these illnesses increases with exposure to coal byproducts. Toxins and impurities present in coal have been linked to kidney disease and to hypertension and other cardiovascular disease. The effects also may result from the general inflammatory or systemic consequences of inhaled particles. Effects may be multifactorial, a result of slurry holdings that leach toxins into drinking water and air pollution effects of coal mining and washing. |