OBJECTIVES: We examined the health-related quality of life of residents in mountaintop mining counties of Appalachia using the 2006 national Behavioral Risk Factor Surveillance System.
METHODS: Dependent variables included self-rated health; the number of poor physical, poor mental, and activity limitation days (in the past 30 days); and the Healthy Days Index. Independent variables included metropolitan status, primary care physician supply, and Behavioral Risk Factor Surveillance System behavioral and demographic variables. We compared dependent variables across 3 categories: mountaintop mining (yes or no), other coal mining (yes or no), and a referent nonmining group. We used SUDAAN MULTILOG and multiple linear regression models with post hoc least squares means to test mountaintop mining effects after adjusting for covariates.
RESULTS: Residents of mountaintop mining counties reported significantly more days of poor physical, mental, and activity limitation and poorer self-rated health (P < .01) compared with the other county groupings. Results were generally consistent in separate analyses by gender and age.
CONCLUSIONS: Mountaintop mining areas are associated with the greatest reductions in health-related quality of life even when compared with counties with other forms of coal mining.

Zullig and Hendryx 2011

Risk of bias

Epidemiological study populations

HAWC