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Mortality Disparities in Appalachia: Reassessment of Major Risk Factors

Borak, Jonathan MD; Salipante-Zaidel, Catherine MEM; Slade, Martin D. MPH; Fields, Cheryl A. MPH


The following Table revises Table 3, which appeared on page 153 of our recent report.1 Table presented here incorporates two sets of changes: 1) We corrected an error in the rural-urban category that had affected the results for that variable and the model. 2) In a letter to the editor, Hendryx and Ahern challenged our findings and they also posted their dataset for these variables.2 As discussed in our reply to their letter, we determined that there were differences between our datasets for seven other variables, of which four (adjusted mortality rate; high school education rate; college education rate; and coal mining (yes/no)) were significantly different.3 We have not determined which of the datasets, ours or theirs, is “more correct” for six of those variables, but their coal mining variable is clearly incorrect. To avoid further disputes, the following Table incorporates the WVU data for adjusted mortality, high school education and college education rates.

The analytical results are quantitatively different from our original report, but qualitatively unchanged. Coal mining remains not significantly associated with mortality. We regret any inconvenience caused by our error in assigning the Rural-Urban category variables.

Journal of Occupational and Environmental Medicine. 54(7):899, July 2012.

Journal of Occupational and Environmental Medicine: February 2012 - Volume 54 - Issue 2 - p 146–156
doi: 10.1097/JOM.0b013e318246f395
Original Articles

Objective: To determine the predictive value of coal mining and other risk factors for explaining disproportionately high mortality rates across Appalachia.

Method: Mortality and covariate data were obtained from publicly available databases for 2000 to 2004. Analysis employed ordinary least square multiple linear regression with age-adjusted mortality as the dependent variable.

Results: Age-adjusted all-cause mortality was independently related to Poverty Rate, Median Household Income, Percent High School Graduates, Rural–Urban Location, Obesity, Sex, and Race/Ethnicity, but not Unemployment Rate, Percent Uninsured, Percent College Graduates, Physician Supply, Smoking, Diabetes, or Coal Mining.

Conclusions: Coal mining is not per se an independent risk factor for increased mortality in Appalachia. Nevertheless, our results underscore the substantial economic and cultural disadvantages that adversely impact health in Appalachia, especially in the coal-mining areas of Central Appalachia.

From the Department of Epidemiology and Public Health (Dr Borak and Ms Fields), Yale University; Department of Medicine (Dr Borak and Mr Slade), Yale University; and Jonathan Borak & Company (Dr Borak, Ms Salipante-Zaidel and Ms Fields), New Haven, Conn.

Address correspondence to: Jonathan Borak, MD, 234 Church Street (#1100), New Haven, CT 06510 (

The study was supported by the National Mining Association. The results presented here represent the conclusions and opinions solely of the authors. Its publication does not imply endorsement by the National Mining Association. The study sponsor had no role in the study design, analysis or interpretation of the data, or in the writing, preparation, or submission of the manuscript, which was not provided to the sponsors prior to its submission for publication.

Copyright © 2012 by the American College of Occupational and Environmental Medicine