Heart Attacks, Heart Disease And Coal Mining

Higher Coronary Heart Disease and Heart Attack Morbidity in Appalachian Coal Mining Regions

Michael Hendryx and Keith J. Zullig

Preventive Medicine, 2009


Keywords:  Cardiovascular health, coal mining, Appalachian region, environmental health

Purpose: Hendryx and Zullig wanted to see if cardiovascular disease rates were higher in Appalachian coal mining counties.

Important Finding: There are higher rates of cardiovascular disease for both men and women in coal mining portions of Appalachia.

Significant Quotes: “The results suggest that environmental pollution from coal mining may be a contributing factor to population prevalence of [cardiovascular disease] morbidity above documented Appalachian health disparities linked to behavioral and socioeconomic risks.”

Results: Hendryx and Zullig used data from the 2006 U.S. Behavioral Risk Factor Surveillance System (BRFSS), which conducted phone surveys with 51% of the U.S. population in 2006.  The sample for this study was 235,783 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.  Coal mining counties were considered as any counties that have had any mining activity between 1996 and 2006.  For comparison, they looked at non-mining counties outside of Appalachia.

Before and after accounting for controls, the rates for cardiovascular disease were significantly higher in Appalachian coal mining areas, as compared to non-Appalachian, non-mining area.  Some of the controls that the study accounted for included age, smoking, body mass index, alcohol consumption, socioeconomic status, and other such variables that are known to increase cardiovascular disease.

Interestingly, non-Appalachian coal mining areas had significantly lower risk of cardiovascular disease and heart attacks than Appalachian coal mining areas.  The authors had a few ideas for why this may be true: the population density in Appalachian coal mining areas is higher than in other coal mining areas, increasing exposure to mining activities; people live very close to mining operations; Appalachian communities rely heavily on private well water, which may is easily contaminated by ground water.

The authors suggest that disease prevention efforts in Appalachia should be focused on coal mining portions of the region.


Hendryx, M. and K. Zullig. (2009) “Higher Coronary Heart Disease and Heart Attack Morbidity in Appalachian Coal Mining Regions.” Preventive Medicine.