title: Chronic cardiovascular disease mortality in mountaintop mining areas of central Appalachian states.
abstract: OBJECTIVE
  To determine if chronic cardiovascular disease (CVD) mortality rates are higher among residents of mountaintop mining (MTM) areas compared to mining and nonmining areas, and to examine the association between greater levels of MTM surface mining and CVD mortality.
  
  
  METHODS
  Age-adjusted chronic CVD mortality rates from 1999 to 2006 for counties in 4 Appalachian states where MTM occurs (N = 404) were linked with county coal mining data. Three groups of counties were compared: MTM, coal mining but not MTM, and nonmining. Covariates included smoking rate, rural-urban status, percent male population, primary care physician supply, obesity rate, diabetes rate, poverty rate, race/ethnicity rates, high school and college education rates, and Appalachian county. Linear regression analyses examined the association of mortality rates with mining in MTM areas and non-MTM areas and the association of mortality with quantity of surface coal mined in MTM areas.
  
  
  RESULTS
  Prior to covariate adjustment, chronic CVD mortality rates were significantly higher in both mining areas compared to nonmining areas and significantly highest in MTM areas. After adjustment, mortality rates in MTM areas remained significantly higher and increased as a function of greater levels of surface mining. Higher obesity and poverty rates and lower college education rates also significantly predicted CVD mortality overall and in rural counties.
  
  
  CONCLUSIONS
  MTM activity is significantly associated with elevated chronic CVD mortality rates. Future research is necessary to examine the socioeconomic and environmental impacts of MTM on health to reduce health disparities in rural coal mining areas.
authors.affiliation: Department of Community Medicine, West Virginia University, Morgantown, West Virginia 26506, USA. lesch@hsc.wvu.edu
authors.forename: Laura
authors.initials: L
authors.lastname: Esch
authors.forename: Michael
authors.initials: M
authors.lastname: Hendryx
mesh_terms: D000328:Adult; D000531:Altitude; D001061:Appalachian Region / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000401:mortality*; D002908:Chronic Disease; D003032:Coal Mining; D016208:Databases, Factual; D054624:Health Status Disparities; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011203:Poverty; D012423:Rural Health