Coal Mining And Quality Of Life

A Comparative Analysis of Health-Related Quality of Life for Residents of U.S. Counties with and without Coal Mining

Keith J. Zullig and Michael Hendryx

Public Health Reports, July – August 2010


Keywords: Health, Appalachia, coal mining, quality of life

Purpose: Zullig and Hendryx wanted to study the population-wide health risks of coal mining.  They aimed to compare health in mining and non-mining communities in and out of Appalachia at an individual level (rather than county-wide), and to relate these differences to socioeconomic, behavioral, and environmental influences (including the presence of coal mining).

Important Finding:  People living in coal mining counties reported poorer health than those in non-mining counties in and out of Appalachia, and those living in Appalachian coal mining areas were worst of all.

Significant Quote: “If these results were extended…across an average American lifetime of 78 years, that is approximately 462 days (15.5 months) of HRQOL impairment directly associated with residence in a coal-mining county in Appalachia, and 283 days (9.5 months) for an average resident in a coal-mining county outside Appalachia.”

Results:  Zullig and Hendryx looked at health-related quality of life (HRQOL) in mining and non-mining counties in and out of Appalachia.  This measures quality of life through self-reported health status over the previous thirty days, including self-rated health, number of poor physical health days, number of poor mental health days, and number of activity limitation days—these were the dependent variables in the study.  They gathered this information from the data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS), which conducted phone surveys with 51% of the U.S. population in 2006. 

This information was then compared to the independent variables, including smoking, body mass index, alcohol consumption, and age.  The information was then further sorted by whether the county of residence had coal mining and was in Appalachia.

The sample for this study was a total of 236,195 people, drawn from 37% of the nation’s counties.  37% of Appalachia’s counties were included, and 43% of the Appalachian counties with coal mining.

The study found that Appalachian coal mining counties have significantly lower rates of health.  Before covariates were accounted for, residents in Appalachian counties without coal mining had 1.30 greater odds of reporting poorer health when compared with non-Appalachian non-coal mining counties.  Residents of coal-mining Appalachian counties had 1.56 greater odds of reporting poorer health.  So, residents in coal mining parts of Appalachia were reporting poorer health compared to all other groups. 

Interestingly, after accounting for all covariates, the poor health problems in Appalachian coal mining counties remained, while health problems in non-coal mining parts of Appalachia disappeared. At the same time, non-Appalachian coal mining counties started to look more like the Appalachian coal mining counties.  In summary: Once you account for covariates, it’s clear that coal mining (whether or not it’s in Appalachia) leads to poorer health in an area.  At the same time, Appalachian coal mining areas show worse results than non-Appalachian, and this may be due to the close proximity of residences to coal mining operations in the former.


Zullig, K. and M. Hendryx. (2010) “A Comparative Analysis of Health-Related Quality of Life for Residents of U.S. Counties with and without Coal Mining.” Public Health Reports, Volume 125.