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

Autor: Cody Goessl, Wen You, Susan Meacham, Ruoding Shi, Yu Sun, George C. Davis
Rok vydání: 2019
Předmět:
Adult
Male
medicine.medical_specialty
Cross-sectional study
complex mixtures
Health Services Accessibility
Young Adult
03 medical and health sciences
0302 clinical medicine
Risk Factors
Environmental health
Epidemiology
otorhinolaryngologic diseases
medicine
Humans
Appalachia
030212 general & internal medicine
Socioeconomic status
Appalachian Region
Health disparity
Insurance
Health
Health access
business.industry
lcsh:Public aspects of medicine
Public health
Smoking
technology
industry
and agriculture
Public Health
Environmental and Occupational Health
Coal mining
lcsh:RA1-1270
Middle Aged
Respiration Disorders
030210 environmental & occupational health
Health equity
respiratory tract diseases
Occupational Diseases
Coal
Cross-Sectional Studies
Social Class
Community health
Respiratory mortality
Female
Biostatistics
business
Research Article
Zdroj: BMC Public Health, Vol 19, Iss 1, Pp 1-16 (2019)
BMC Public Health
ISSN: 1471-2458
Popis: 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-valuep-value 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.
Databáze: OpenAIRE
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