An examination of the effects of mountaintop removal coal mining on respiratory symptoms and COPD using propensity scores

Association of Environmental Injustice and Cardiovascular Diseases and Risk Factors in the United States

BACKGROUND

While the impacts of social and environmental exposure on cardiovascular risks are often reported individually, the combined effect is poorly understood.

METHODS AND RESULTS

Using the 2022 Environmental Justice Index, socio-environmental justice index and environmental burden module ranks of census tracts were divided into quartiles (quartile 1, the least vulnerable census tracts; quartile 4, the most vulnerable census tracts). Age-adjusted rate ratios (RRs) of coronary artery disease, strokes, and various health measures reported in the Prevention Population-Level Analysis and Community Estimates data were compared between quartiles using multivariable Poisson regression. The quartile 4 Environmental Justice Index was associated with a higher rate of coronary artery disease (RR, 1.684 [95% CI, 1.660-1.708]) and stroke (RR, 2.112 [95% CI, 2.078-2.147]) compared with the quartile 1 Environmental Justice Index. Similarly, coronary artery disease 1.057 [95% CI,1.043-1.0716] and stroke (RR, 1.118 [95% CI, 1.102-1.135]) were significantly higher in the quartile 4 than in the quartile 1 environmental burden module. Similar results were observed for chronic kidney disease, hypertension, diabetes, obesity, high cholesterol, lack of health insurance, sleep <7 hours per night, no leisure time physical activity, and impaired mental and physical health >14 days.

CONCLUSIONS

The prevalence of CVD and its risk factors is highly associated with increased social and environmental adversities, and environmental exposure plays an important role independent of social factors.

Developing evolutionary anthropology in local ecosystems

The traditional regional focus of evolutionary anthropology-typically defined as places where hominin fossils, nonhuman primates, and non-western populations reside-forms the basis of much evolutionary anthropological research. Using the highly biodiverse temperate region of Appalachia as an example, we suggest that evolutionary anthropologists have much to gain by stepping outside of this traditional geographic area. Being purposely provocative, we argue that evolutionary anthropologists might also benefit from conducting research in Appalachia and other temperate ecosystems. We briefly discuss multiple areas of study-including studies of seed dispersal, functional redundancy, convergent evolution, human behavioral ecology, and conservation-and how they can be considered within the purview of integrative and evolutionary anthropology. We also highlight broader impacts to higher education that evolutionary anthropologists can help promote by working in local ecosystems.

Environmental exposures and pulmonary function among adult residents of rural Appalachian Kentucky

BACKGROUND

Estimated residential exposures of adults to roadway density and several metrics of resource extraction, including coal mining and oil and gas drilling, were hypothesized to contribute to the prevalence of respiratory disease in rural Appalachia.

OBJECTIVE

Determine how small-area geographic variation in residential environmental exposures impacts measures of pulmonary function among adults in a community-based study.

METHODS

We examined associations between residential environmental respiratory exposures and pulmonary function among 827 adult participants of the "The Mountain Air Project", a community-based, cross-sectional study in Southeastern Kentucky during 2016-2018. Exposures characterized the density of roadways, oil/gas wells, or current/past surface and underground coal mining at the level of 14-digit hydrologic unit code (HUC), or valley "hollow" where participants resided. Each participant completed an in-person interview to obtain extensive background data on risk factors, health history, and occupational and environmental exposures, as well as a spirometry test administered by experienced study staff at their place of residence. Multivariable linear regression was used to model the adjusted association between each environmental exposure and percent predicted forced expiratory volume in one second (FEV1PP) and forced vital capacity (FVCPP).

RESULTS

Adjusted regression models indicate persons living in HUCs with the highest level of roadway density experienced a reduction in both FEV1PP (-4.3: 95% CI: -7.44 -1.15;) and FVCPP (-3.8: 95% CI: -6.38, -1.21) versus persons in HUCs with the lowest roadway density. No associations were detected between the metrics associated with mining and oil and gas operations and individual pulmonary function.

IMPACT STATEMENT

Our work demonstrates the potential adverse impact of roadway-related exposures on the respiratory health of rural Appalachia residents. We employed a novel method of small-area exposure classification based on the hydrologic unit code (HUC), representing potential exposure levels per hollow occurring  in proximity to the residence, and controlled for individual-level risk factors for reduced respiratory health. We highlight an overlooked yet ubiquitous source of residential exposure from motor vehicles that may contribute to the regionally high prevalence of respiratory disease in rural Appalachia.

Public health impact of coal-fired power plants: a critical systematic review of the epidemiological literature

Coal-based energy production is the most utilized method of electricity production worldwide and releases the highest concentration of gaseous, particulate, and metallic pollutants. Toxicological research has shown that coal combustion by-products are carcinogens, endocrine disruptors, and cardiorespiratory toxins. This article aims to systematically review the epidemiological literature on the impact emissions from coal-based power production has on morbidity and mortality worldwide. Two thousand one hundred and fifty-two articles were retrieved based on search criteria. Word search of abstract and article text filtered the results to 95 articles. Forty articles were included after screening. The literature indicates a significant adverse effect from particulate matter and polyaromatic hydrocarbon emissions on morbidity and mortality. There is a lack of consistency of exposure assessment and inadequate control of significant potential confounders such as social economic status. Future research should focus on improving exposure assessment models, specifically source-apportionment and geographic information system methods to model power plant-specific emissions.

Health information source use and trust among a vulnerable rural disparities population

PURPOSE

Because rural residents, particularly those near mining sites, are susceptible to numerous environmental health hazards, it is important to gain deeper insights into their use and trust of health information, which they may employ to help recognize symptoms, learn ways to reduce exposure, or find health care.

METHODS

We surveyed residents (N = 101) of rural Kentucky, Virginia, and West Virginia to assess predictors of health information source use and trust. A project manager administered face-to-face paper and pencil questionnaires assessing demographics, health status, smoking behavior, and health information use and source trust. Bivariate correlations and ordinary least squares regressions were used to analyze the data.

FINDINGS

The data suggest that rural individuals frequently use nurses, doctors, and websites to seek health information, whereas traditional media are often not their preferred channel for health information. Media sources were not found as trustworthy as interpersonal and medical health information sources. While only 13.0% of individuals in the sample said they ever turned to county or state health departments for health information, these sources were trusted more than any media source and more than friends. Moreover, living closer to active mining sites-meaning these individuals are at a higher risk of environmental health hazards-predicted even less use of traditional media and greater trust in peer sources.

CONCLUSIONS

Not all sources of health information are equally used or trusted by individuals from a rural disparities population. The findings have implications for health campaign message dissemination and intervention designs targeting individuals in rural Appalachia.

Air Pollution Emissions 2008-2018 from Australian Coal Mining: Implications for Public and Occupational Health

Occupational exposure limits for respirable coal dust are based on exposure during working hours, but coal miners may experience additional community-based exposures during nonworking hours. We analyzed Australia National Pollutant Inventory (NPI) data for the years 2008–2018 to estimate air pollutants (metals, nitrogen oxides, particulate matter ≤ 10 micrometers (PM10) and ≤2.5 micrometers (PM2.5)) originating from coal mines. PM10 levels from community-based air monitors in Queensland and New South Wales were also compared between mining and nonmining communities. Results indicated that tons of coal mined increased over the study period, and that levels of particulate matter, metals, and nitrogen oxides increased significantly over time as well. Coal mines accounted for 42.1% of national PM10 air emissions from NPI sites. PM2.5 from coal mines accounted for 19.5% of the national total, metals for 12.1%, and nitrogen oxides for 10.1%. Coal mining occurred in 57 different post codes; the 20 coal-mining post codes with the highest PM10 emissions were home to 160,037 people. Emissions of all studied pollutants were significantly higher from coal mining sites than from other types of NPI sites. Results from community-based air monitoring stations indicated significantly higher population PM10 exposure in coal mining communities than in nonmining communities. The health of the public at large is impacted by coal mining, but to the extent that miners also live near coal mining operations, their total exposure is underestimated by consideration of exposure only during working hours.

Impacts of Coal Use on Health

This article reviews evidence for the public health impacts of coal across the extraction, processing, use, and waste disposal continuum. Surface coal mining and processing impose public health risks on residential communities through air and water pollution. Burning coal in power plants emits more nitrogen oxides, sulfur dioxide, particulate matter, and heavy metals per unit of energy than any other fuel source and impairs global public health. Coal ash disposal exposes communities to heavy metals and particulate matter waste. Use of coal in domestic households causes public health harm concentrated in developing nations. Across the coal continuum, adverse impacts are disproportionately felt by persons of poor socioeconomic status, contributing to health inequities. Despite efforts to develop renewable energy sources, coal use has not declined on a global scale. Concentrated efforts to eliminate coal as an energy source are imperative to improve public health and avert serious climate change consequences.

Associations between Respiratory Health Outcomes and Coal Mine Fire PM2.5 Smoke Exposure: A Cross-Sectional Study

In 2014, wildfires ignited a fire in the Morwell open cut coal mine, Australia, which burned for six weeks. This study examined associations between self-reported respiratory outcomes in adults and mine fire-related PM_2.5 smoke exposure. Self-reported data were collected as part of the Hazelwood Health Study Adult Survey. Eligible participants were adult residents of Morwell. Mine fire-related PM_2.5 concentrations were provided by the Commonwealth Scientific and Industrial Research Organisation Oceans & Atmosphere Flagship. Personalised mean 24-h and peak 12-h mine fire-related PM_2.5 exposures were estimated for each participant. Data were analysed by multivariate logistic regression. There was some evidence of an association between respiratory outcomes and mine fire PM_2.5 exposure. Chronic cough was associated with an odds ratio (OR) of 1.13 (95% confidence interval 1.03 to 1.23) per 10 μg/m³ increment in mean PM_2.5 and 1.07 (1.02 to 1.12) per 100 μg/m³ increment in peak PM_2.5. Current wheeze was associated with peak PM_2.5, OR = 1.06 (1.02 to 1.11) and chronic phlegm with mean PM_2.5 OR = 1.10 (1.00 to 1.20). Coal mine PM_2.5 smoke exposure was associated with increased odds of experiencing cough, phlegm and wheeze. Males, participants 18–64 years, and those residing in homes constructed from non-brick/concrete materials or homes with tin/metal roofs had higher estimated ORs. These findings contribute to the formation of public health policy responses.

Association between ambient temperature and chronic obstructive pulmonary disease: a population-based study of the years of life lost

Limited evidence on the burden of chronic obstructive pulmonary disease (COPD) attributable to ambient temperature. We aim to explore the association between ambient temperature and years of life lost (YLL), and to get a more intuitive understanding of the dangers of COPD in China. Death and meteorological data of 31 Chinese provincial capital cities during 2008-2013 was analyzed in this study. Distributed Lag Non-linear Model (DLNM) was used to estimate the association between ambient temperature and mortality. The attributable fraction (AF) to cold effect ranged from 8.19 (95%CI: -8.52,19.38) to 28.98 (95%CI: -64.78,67.59), while the AF to heat effect varied from 0.02 (95%CI: -0.13,0.05) to 5.73 (95%CI: 0.31,10.22). Cold effect was higher than heat effect on COPD in women and elderly, heat effect was higher in men and younger. Low temperature can cause more serious disease burden of COPD than high temperature.

Mountaintop removal mining and multiple illness symptoms: A latent class analysis

BACKGROUND

Mountaintop removal mining has been associated with multiple types of disease outcomes for populations living nearby. The current study tested whether latent classes identifying people with symptoms from multiple organ systems were associated with residence in mountaintop mining communities.

METHODS

We used data from three cross-sectional household community surveys conducted in three Appalachian states (N = 2756). The surveys contained information on 29 recent illness symptoms grouped into eight organ systems (respiratory, cardiovascular, gastrointestinal, musculoskeletal, skin, eye-ear-nose-throat, neurological, and other.) We identified latent classes, and then tested whether classes with higher probabilities of multiple symptoms would be associated with residence in mountaintop removal areas after control for covariates.

RESULTS

Three latent classes were identified, including a low-symptom referent class, an intermediate class, and a class with high symptom probability across organ systems. Controlling for covariates, latent classes characterized by intermediate and high multi-symptom probabilities were significantly associated with residence near mountaintop removal mining, with the highest odds ratio for the MTR versus control condition for the high multi-symptom group (OR = 2.17, 95% CI = 1.80-2.61).

CONCLUSIONS

Symptoms across multiple organ systems were related to residential proximity to mountaintop removal mining. Prior research has established multiple environmental contaminants related to mining that may contribute to poor population health through more than one exposure route or chemical of concern.

Systematic review of community health impacts of mountaintop removal mining

BACKGROUND

The objective of this evaluation is to understand the human health impacts of mountaintop removal (MTR) mining, the major method of coal mining in and around Central Appalachia. MTR mining impacts the air, water, and soil and raises concerns about potential adverse health effects in neighboring communities; exposures associated with MTR mining include particulate matter (PM), polycyclic aromatic hydrocarbons (PAHs), metals, hydrogen sulfide, and other recognized harmful substances.

METHODS

A systematic review was conducted of published studies of MTR mining and community health, occupational studies of MTR mining, and any available animal and in vitro experimental studies investigating the effects of exposures to MTR-mining-related chemical mixtures. Six databases (Embase, PsycINFO, PubMed, Scopus, Toxline, and Web of Science) were searched with customized terms, and no restrictions on publication year or language, through October 27, 2016. The eligibility criteria included all human population studies and animal models of human health, direct and indirect measures of MTR-mining exposure, any health-related effect or change in physiological response, and any study design type. Risk of bias was assessed for observational and experimental studies using an approach developed by the National Toxicology Program (NTP) Office of Health Assessment and Translation (OHAT). To provide context for these health effects, a summary of the exposure literature is included that focuses on describing findings for outdoor air, indoor air, and drinking water.

RESULTS

From a literature search capturing 3088 studies, 33 human studies (29 community, four occupational), four experimental studies (two in rat, one in vitro and in mice, one in C. elegans), and 58 MTR mining exposure studies were identified. A number of health findings were reported in observational human studies, including cardiopulmonary effects, mortality, and birth defects. However, concerns for risk of bias were identified, especially with respect to exposure characterization, accounting for confounding variables (such as socioeconomic status), and methods used to assess health outcomes. Typically, exposure was assessed by proximity of residence or hospital to coal mining or production level at the county level. In addition, assessing the consistency of findings was challenging because separate publications likely included overlapping case and comparison groups. For example, 11 studies of mortality were conducted with most reporting higher rates associated with coal mining, but many of these relied on the same national datasets and were unable to consider individual-level contributors to mortality such as poor socioeconomic status or smoking. Two studies of adult rats reported impaired microvascular and cardiac mitochondrial function after intratracheal exposure to PM from MTR-mining sites. Exposures associated with MTR mining included reports of PM levels that sometimes exceeded Environmental Protection Agency (EPA) standards; higher levels of dust, trace metals, hydrogen sulfide gas; and a report of increased public drinking water violations.

DISCUSSION

This systematic review could not reach conclusions on community health effects of MTR mining because of the strong potential for bias in the current body of human literature. Improved characterization of exposures by future community health studies and further study of the effects of MTR mining chemical mixtures in experimental models will be critical to determining health risks of MTR mining to communities. Without such work, uncertainty will remain regarding the impact of these practices on the health of the people who breathe the air and drink the water affected by MTR mining.

Atmospheric particulate matter in proximity to mountaintop coal mines: sources and potential environmental and human health impacts

Mountaintop removal mining (MTM) is a widely used approach to surface coal mining in the US Appalachian region whereby large volumes of coal overburden are excavated using explosives, removed, and transferred to nearby drainages below MTM operations. To investigate the air quality impact of MTM, the geochemical characteristics of atmospheric particulate matter (PM) from five surface mining sites in south central West Virginia, USA, and five in-state study control sites having only underground coal mining or no coal mining whatsoever were determined and compared. Epidemiologic studies show increased rates of cancer, respiratory disease, cardiovascular disease, and overall mortality in Appalachian surface mining areas compared to Appalachian non-mining areas. In the present study, 24-h coarse (>2.5 µm) and fine (≤2.5 µm) PM samples were collected from two surface mining sites in June 2011 showed pronounced enrichment in elements having a crustal affinity (Ga, Al, Ge, Rb, La, Ce) contributed by local sources, relative to controls. Follow-up sampling in August 2011 lacked this enrichment, suggesting that PM input from local sources is intermittent. Using passive samplers, dry deposition total PM elemental fluxes calculated for three surface mining sites over multi-day intervals between May and August 2012 were 5.8 ± 1.5 times higher for crustal elements than at controls. Scanning microscopy of 2,249 particles showed that primary aluminosilicate PM was prevalent at surface mining sites compared to secondary PM at controls. Additional testing is needed to establish any link between input of lithogenic PM and disease rates in the study area.