We compared health-related quality of life (HRQOL) in mining and non-mining counties in and out of Appalachia using the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey.
Methods.
Dependent variables included self-rated health, the number of poor physical and mental health days, the number of activity limitation days (in the last 30 days), and the Centers for Disease Control and Prevention Healthy Days Index. Independent variables included the presence of coal mining, Appalachian region residence, metropolitan status, primary care physician supply, and BRFSS behavioral (e.g., smoking, body mass index, and alcohol consumption) and demographic (e.g., age, gender, race, and income) variables. We compared dependent variables across a four-category variable: Appalachia (yes/no) and coal mining (yes/no). We used SUDAAN® Multilog and multiple linear regression models with post-hoc least-squares means to test for Appalachian coal-mining effects after adjusting for covariates.
Results.
Residents of coal-mining counties inside and outside of Appalachia reported significantly fewer healthy days for both physical and mental health, and poorer self-rated health (p<0.0005) when compared with referent U.S. non-coal-mining counties, but disparities were greatest for people residing in Appalachian coal-mining areas. Furthermore, results remained consistent in separate analyses by gender and age.
Conclusions.
Coal-mining areas are characterized by greater socioeconomic disadvantage, riskier health behaviors, and environmental degradation that are associated with reduced HRQOL.
References
1.
CoggonDTaylorAN. Coal mining and chronic obstructive pulmonary disease: A review of the evidence. Thorax1998;53:398–407.
2.
MontesI IsidroFernandezG RegoRegueroJMirMA CosioGarcia-OrdasEMartinezJL Anton. Respiratory disease in a cohort of 2,579 coal miners followed up over a 20-year period. Chest2004;126:622–9.
3.
ScottDFGraysonRLMetzEA. Disease and illness in U.S. mining, 1983–2001. J Occup Environ Med2004;46:1272–7.
4.
HendryxM. Mortality rates in Appalachian coal mining counties: 24 years behind the nation. Environmental Justice2008;1:5–11.
5.
HendryxM. Mortality from heart, respiratory, and kidney disease in coal mining areas of Appalachia. Int Arch Occup Environ Health2009;82:243–9.
6.
HendryxMO'DonnellKHornK. Lung cancer mortality is elevated in coal mining areas of Appalachia. Lung Cancer2008;62:1–7.
7.
ZhangZInfanteAMeitMEnglishNDunnMBowersK. Analysis of mental health and substance abuse disparities & access to treatment services in the Appalachian region. Final report. Washington: Appalachian Regional Commission; 2008.
8.
WingoPATuckerTCJamisonPMMartinHMcLaughlinCBayaklyR. Cancer in Appalachia, 2001–2003. Cancer2008;112:181–92.
9.
CaudillHM. Night comes to the Cumberlands: A biography of a depressed area. Ashland (KY): Jesse Stuart Foundation; 2001.
10.
Cancer death rates—Appalachia, 1994–1998. MMWR Morb Mortal Wkly Rep2002;51(24):527–9.
11.
HalversonJAMaLHarnerEJ. An analysis of disparities in health status and access to health care in the Appalachian region. Washington: Appalachian Regional Commission; 2004.
12.
HendryxMAhernM. Relations between health indicators and residential proximity to coal mining in West Virginia. Am J Public Health2008;98:669–71.
13.
Department of Health and Human Services (US). Healthy People 2010: Understanding and improving health [cited 2009 Feb 13]. Available from: URL: http://web.health.gov/healthypeople
14.
HennessyCHMoriartyDGZackMMScherrPABrackbillR. Measuring health related quality of life for public health surveillance. Public Health Rep1994;109:665–72.
15.
Quality of life as a new public health measure—Behavioral Risk Factor Surveillance System. MMWR Morb Mortal Wkly Rep1994;43(20):375–80.
16.
BallisDSSegallAChipperfieldJG. Two views of self-rated general health status. Soc Sci Med2003;56:203–17.
17.
BenjaminsMRHummerRAEbersteinIWNamCB. Self-reported health and adult mortality risk: An analysis of cause-specific mortality. Soc Sci Med2004;59:1297–306.
18.
FarkasJNabbSZaletel-KrageljLClelandJGLainscakM. Self-rated health and mortality in patients with chronic heart failure. Eur J Heart Fail2009;11:518–24.
19.
IdlerELBenyaminiY. Self-rated health and mortality. A review of twenty-seven community studies. J Health Soc Behav1997;38:21–37.
20.
SegoviaJBartlettRFEdwardsAC. The association between self-assessed health status and individual health practices. Can J Public Health1989;80:32–7.
21.
NewschafferCJ. Validation of Behavioral Risk Factor Surveillance System (BRFSS) HRQOL measures in a statewide sample: Final report. Atlanta: Department of Health and Human Services (US), Office of Disease Prevention and Health Promotion; 1998.
22.
AndresenEMCatlinTKWyrichKWJackson-ThompsonJ. Retest reliability of surveillance questions on health related quality of life. J Epidemiol Community Health2003;57:339–43.
23.
NandaUAndresenEM. Performance of measures of health-related quality of life and function among disabled adults. Qual Life Res1998;7:644.
24.
AndresenEMFoutsBSRomeisJCBrownsonCA. Performance of health-related quality-of-life instruments in a spinal cord injury population. Arch Phys Med Rehabil1999;80:877–84.
25.
DiwanSMoriartyD. A conceptual framework for identifying unmet health care needs of community dwelling elderly. J Appl Gerontol1995;14:47–63.
26.
NelsonDEHoltzmanDBolenJStanwyckCAMackKA. Reliability and validity of measures from the Behavioral Risk Factor Surveillance System (BRFSS). Soz Praventivmed2001;46Suppl 1:S3–42.
27.
Centers for Disease Control and Prevention (US). Behavioral Risk Factor Surveillance System operational and user's guide version 3.0. 2006 [cited 2009 Mar 23]. Available from: URL: ftp://ftp.cdc.gov/pub/Data/Brfss/userguide.pdf
Research Triangle Institute. SUDAAN®: Version 9.0.1. Research Triangle Park (NC): Research Triangle Institute; 2005.
31.
CohenJ. Statistical power analysis for the behavioral sciences. Hillsdale (NJ): Lawrence Earlbaum Associates; 1988.
32.
SehulsterJR. Health and self: Paths for exploring cognitive aspects underlying self-report of health status. In: SchechterS, editor. Proceedings of the 1993 NCHS Conference on the Cognitive Aspects of Self-Reported Health Status, Working Paper Series, No. 10. Hyattsville (MD): Department of Health and Human Services (US); 1994. p. 89–105.
33.
MosseyJMShapiroE. Self-rated health: A predictor of mortality among the elderly. Am J Public Health1982;72:800–8.
34.
KaplanGACamachoT. Perceived health and mortality: A nine-year follow-up of the Human Population Laboratory cohort. Am J Epidemiol1983;117:292–304.
35.
IdlerELKasiSVLemkeJH. Self-evaluated health and mortality among the elderly in New Haven, Connecticut, and Iowa and Washington Counties, Iowa, 1982–1986. Am J Epidemiol1990;131:91–103.
36.
StoutBMIIIPapilloJ. Well water quality in the vicinity of a coal slurry impoundment near Williamson, West Virginia. Wheeling (WV): Wheeling Jesuit University; 2004.
37.
GhoseMKBanerjeeSK. Status of air pollution caused by coal washery projects in India. Environ Monk Assess1995;38:97–105.
38.
MonfortonC. Weight of the evidence or wait for the evidence? Protecting underground miners from diesel particulate matter. Am J Public Health2006;96:271–6.
