Appalachia; Appalachian Region; Coal mines and mining; Coal mining; Environmental justice; Mortality; Poor – Mortality; Poverty


Community-Based Research | Demography, Population, and Ecology | Environmental Public Health | Public Health | Vital and Health Statistics


Objectives. This study investigated the associations between poverty rates, Appalachian mountaintop coal mining, and age-adjusted total mortality rates to determine if persons exposed to this form of mining experience greater poverty and higher death rates compared to other types of mining or other areas of Appalachia.

Methods. Mortality rates, poverty rates, Appalachian designation and mining activity were examined for counties in Kentucky, Tennessee, Virginia and West Virginia (N=403). Linear least squares models tested for annual group differences from 2000-2007 in total and child poverty, and total mortality, based on mining type and Appalachian location. Nested linear models accounting for state-level effects were used to determine whether mountaintop mining and poverty were associated with mortality rates controlling for other risks.

Results. Mountaintop mining areas had significantly higher mortality rates, total poverty rates and child poverty rates every year compared to other referent counties of these states. Both poverty and mountaintop mining were independently associated with age-adjusted mortality rates in nested models.

Conclusions. Persons living in MTM areas experience persistently elevated poverty and mortality rates. Higher mortality is independently associated with both poverty and MTM, the latter effect suggestive of a possible environmental contribution from mining activities. Efforts to reduce longstanding health disparities in Appalachia must focus on those areas where disparities are concentrated: the Appalachian coalfields.