142nd APHA Annual Meeting and Exposition

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Disparities in Diabetes Mellitus Mortality Rates in Coal Mining and Non-Coal Mining Areas of Appalachia

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 8:30 AM - 8:42 AM

Jeanine Buchanich, Ph.D., M.Ed. , Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
Evelyn O. Talbott, DrPH, MPH , Department of Epidemiology, Director University of Pittsburgh Academic Center for Excellence in Environmental PH Tracking, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
Ada Youk, Ph.D. , University of Pittsburgh, Pittsburgh, PA
Lauren Balmert , Graduate School of Public Health Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
Shannon Woolley , Graduate School of Public Health Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
Objective: Recent studies have indicated that adverse health outcomes occur at higher rates in the Appalachian region of the US and that West Virginia has the highest prevalence of diabetes mellitus (DM) in the US.  However, conflicting evidence has been found regarding whether these disparities are due in part to coal mining in Appalachia or to other social, economic, or health factors.

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 prevention
Environmental health sciences

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

Presenting author's disclosure statement:

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.