301769
Disparities in Diabetes Mellitus Mortality Rates in Coal Mining and Non-Coal Mining Areas of Appalachia
Methods: We computed unadjusted and covariate-adjusted negative binomial regression rate ratio (RR) models to compare DM mortality (10th revision ICD codes E10-E14) RRs by quartile of cumulative coal mined in 31 Appalachian coal mining and 31 Appalachian non-coal mining counties from 1960-2009. We also examined decade-specific RRs adjusted for coal and covariates. Univariately statistically significant county-level potential confounding factors included were percent unemployed; percent of population below poverty line; percent non-white; county urban-rural continuum code; smoking prevalence; and obesity prevalence.
Results: Before adjustment, coal was a statistically significant predictor of DM mortality in the RR models, with coal production quartile-specific RRs ranging from 0.99 (2nd quartile) to 1.37 (4th quartile). After adjustment for the covariates, coal was not statistically significant in the RR model and quartile-specific RRs decreased by 3%-32%. In coal and covariate adjusted decade-specific models with 1960-1969 as the baseline, RRs were statistically significantly elevated for all decades with a nearly 2-fold excess for coal mining compared to non-coal mining counties in the 2000-2009 time period.
Conclusions: Coal mining was not associated with DM mortality after controlling for socioeconomic and health behavior risk factors. However, even after control for potential confounding factors, the risk for DM mortality in coal mining counties has increased over time relative to non-coal mining counties. Additional analyses will need to focus on what other specific factors may be influencing these mortality disparities.
Learning Areas:
Chronic disease management and preventionEnvironmental health sciences
Epidemiology
Learning Objectives:
Compare diabetes mellitus mortality rates in coal mining and non-coal mining counties of Appalachia
Identify mortality trends from 1960-2009
Compare confounding factors
Formulate plans to address mortality disparities
Keyword(s): Diabetes, Rural Health
Qualified on the content I am responsible for because: I have been the principal investigator on several studies investigating the associations between community health and coal mining in Appalachia. My main research interests are environmental and occupational health and I have authored many peer-reviewed scientific publications in these areas.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.