title: Mortality in Appalachian coal mining regions: the value of statistical life lost.
abstract: OBJECTIVE
  We examined elevated mortality rates in Appalachian coal mining areas for 1979-2005, and estimated the corresponding value of statistical life (VSL) lost relative to the economic benefits of the coal mining industry.
  
  
  METHODS
  We compared age-adjusted mortality rates and socioeconomic conditions across four county groups: Appalachia with high levels of coal mining, Appalachia with lower mining levels, Appalachia without coal mining, and other counties in the nation. We converted mortality estimates to VSL estimates and compared the results with the economic contribution of coal mining. We also conducted a discount analysis to estimate current benefits relative to future mortality costs.
  
  
  RESULTS
  The heaviest coal mining areas of Appalachia had the poorest socioeconomic conditions. Before adjusting for covariates, the number of excess annual age-adjusted deaths in coal mining areas ranged from 3975 to 10,923, depending on years studied and comparison group. Corresponding VSL estimates ranged from $18.563 billion to $84.544 billion, with a point estimate of $50.010 billion, greater than the $8.088 billion economic contribution of coal mining. After adjusting for covariates, the number of excess annual deaths in mining areas ranged from 1736 to 2889, and VSL costs continued to exceed the benefits of mining. Discounting VSL costs into the future resulted in excess costs relative to benefits in seven of eight conditions, with a point estimate of $41.846 billion.
  
  
  CONCLUSIONS
  Research priorities to reduce Appalachian health disparities should focus on reducing disparities in the coalfields. The human cost of the Appalachian coal mining economy outweighs its economic benefits.
authors.affiliation: Department of Community Medicine, Institute for Health Policy Research, West Virginia University, Morgantown, WV 26506, USA. mhendryx@hsc.wvu.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Hendryx
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Ahern
mesh_terms: D001061:Appalachian Region / Q000453:epidemiology; D003032:Coal Mining; D054624:Health Status Disparities; D006801:Humans; D009026:Mortality / Q000639:trends*; D012189:Retrospective Studies; D012923:Social Class; D026712:Value of Life / Q000191:economics*