Mortality Disparities in Appalachia: Reassessment of Major Risk Factors

• Published in: Journal of occupational and environmental medicine 2012-02, Vol.54 (2), p.146-156
• Main Authors: Borak, Jonathan, Salipante-Zaidel, Catherine, Slade, Martin D., Fields, Cheryl A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Appalachian Region - epidemiology; Appalachian Region - ethnology; Biological and medical sciences; Coal; Coal mining; Coal Mining - statistics & numerical data; Continental Population Groups - statistics & numerical data; Culture; diabetes mellitus; Diabetes Mellitus - epidemiology; Economics; Environment. Living conditions; Environmental health; Ethnic groups; Female; Health Status Disparities; Households; Housing. Living conditions; Humans; Male; Medical sciences; Middle Aged; Mining; Mortality; Mortality - ethnology; Obesity - epidemiology; ORIGINAL ARTICLES; poverty; Poverty - statistics & numerical data; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression analysis; Risk Factors; Rural Population - statistics & numerical data; Smoking - epidemiology; Socioeconomic Factors; Young Adult
• ISSN: 1076-2752; 1536-5948
• DOI: 10.1097/JOM.0b013e318246f395

Objective: To determine the predictive value of coal mining and other risk factors for explaining disproportionately high mortality rates across Appalachia. Method: Mortality and covariate data were obtained from publicly available databases for 2000 to 2004. Analysis employed ordinary least square multiple linear regression with age-adjusted mortality as the dependent variable. Results: Age-adjusted all-cause mortality was independently related to Poverty Rate, Median Household Income, Percent High School Graduates, Rural–Urban Location, Obesity, Sex, and Race/Ethnicity, but not Unemployment Rate, Percent Uninsured, Percent College Graduates, Physician Supply, Smoking, Diabetes, or Coal Mining. Conclusions: Coal mining is not per se an independent risk factor for increased mortality in Appalachia. Nevertheless, our results underscore the substantial economic and cultural disadvantages that adversely impact health in Appalachia, especially in the coal-mining areas of Central Appalachia.