title: Adult tooth loss for residents of US coal mining and Appalachian counties.
abstract: OBJECTIVE
  The authors compared rates of tooth loss between adult residents of Appalachian coal-mining areas and other areas of the nation before and after control for covariate risks.
  
  
  METHODS
  The authors conducted a cross-sectional secondary data analysis that merged 2006 national Behavioral Risk Factor Surveillance System data (BRFSS) (N = 242 184) with county coal-mining data and other county characteristics. The hypothesis tested was that adult tooth loss would be greater in Appalachian mining areas after control for other risks. Primary independent variables included main effects for coal-mining present (yes/no) residence in Appalachia (yes/no), and their interaction. Data were weighted using the BRFSS final weights and analyzed using SUDAAN Proc Multilog to account for the multilevel complex sampling structure. The odds of two measures of tooth loss were examined controlling for age, race\ethnicity, drinking, smoking, income, education, supply of dentists, receipt of dental care, fluoridation rate, and other variables.
  
  
  RESULTS
  After covariate adjustment, the interaction variable for the residents of Appalachian coal-mining counties showed a significantly elevated odds for any tooth loss [odds ratio (OR) = 1.19, 95% CI = 1.02, 1.38], and greater tooth loss measured by a 4-level edentulism scale (OR = 1.20, 95% CI = 1.05, 1.36). The main effect for Appalachia was also significant for both measures, but the main effect for coal mining was not.
  
  
  CONCLUSIONS
  Greater risk of tooth loss among adult residents of Appalachian coal-mining areas is present and is not explained by differences in reported receipt of dental care, fluoridation rates, supply of dentists or other behavioral or socioeconomic risks. Possible contributing factors include mining-specific disparities related to access, behavior or environmental exposures.
authors.affiliation: Department of Community Medicine, School of Medicine, West Virginia University, Morgantown, WV 26506, USA. mhendryx@hsc.wvu.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Hendryx
authors.forename: Alan M
authors.initials: AM
authors.lastname: Ducatman
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Zullig
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Ahern
authors.forename: Richard
authors.initials: R
authors.lastname: Crout
mesh_terms: D001061:Appalachian Region / Q000453:epidemiology; D040343:Behavioral Risk Factor Surveillance System; D003032:Coal Mining / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009066:Mouth, Edentulous / Q000453:epidemiology; D016017:Odds Ratio; D016388:Tooth Loss / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology