Comparative Analysis of Health Related Quality of Life (HRQOL) for Residents of US Counties with and without Coal Mining

Background: HP 2010 identified quality of life improvement as a public health priority. Research has identified significant health problems among Appalachian residents in coal mining areas, but most research has relied on county-level data with limited covariates. This study compared health-related quality of life (HRQOL) in mining and non-mining counties in and out of Appalachia using the 2006 national BRFSS (N=349,287) and related differences to socioeconomic, behavioral, and environmental influences.

Methods: Dependent variables included self-rated health; the number of poor physical and mental health, and activity limitation days, in the last 30; and the CDC Healthy Days Index (created by adding recent poor physical and mental health days subtracted from 30). Independent variables included the presence of coal mining, Appalachian region residence, metropolitan status, primary care physician supply, and BRFSS behavioral (e.g., smoking, BMI, alcohol consumption) and demographic (e.g., age, sex, race, income, etc.) variables. Dependent variables were compared across a categorical variable with four levels: Appalachia (yes and no) and coal mining (yes and no). SUDAAN multiple linear regression models and post-hoc least squares means tested Appalachian coal mining effects after adjusting for covariates.

Results: People in Appalachian coal mining areas reported significantly fewer healthy days, and poorer self-rated health (p<.0005) after controlling for covariates.

Discussion: Appalachian residence was associated with significantly reduced HRQOL, and further magnified for persons residing in Appalachian coal mining areas. Coal mining areas are characterized by greater socioeconomic disadvantage, riskier health behaviors, and environmental degradation leading to reduced HRQOL.