MTR And Chronic Heart Disease

Chronic Cardiovascular Disease Mortality in Mountaintop Mining Areas of Central Appalachian States

Lauren Esch, BS and Michael Hendryx, PhD

The Journal of Rural Health


Keywords: Appalachia, cardiovascular health, coal mining, mortality, rural

Purpose:  While previous studies have looked at the effects of coal mining on cardiovascular health, this paper specifically focuses on the effects of mountaintop removal(MTR) coal mining on cardiovascular health and death rates. 

Important Finding: Cardiovascular related deaths are significantly higher in Appalachian mining areas, as compared to non-mining areas, and they are highest in MTR areas.

Significant Quotes: “The correspondence between mining activity and poor socioeconomic conditions is itself a concern and is consistent with previous research identifying mining-dependent economies as among the weakest in the Appalachian region.  Adverse socioeconomic conditions are a fundamental cause of poor population health outcomes.  Areas of central Appalachia where mining is present have the highest poverty rates and the lowest rates of college education in the region.  [Cardiovascular] mortality is a consequence of these factors in addition to possible MTM-related environmental exposures.”

Results: Esch and Hendryx looked at cardiovascular health problems in MTR areas of Appalachia.  They looked at countywide data from 1996 to 2006 for all of the counties in the mountaintop removal areas of Kentucky, Tennessee, Virginia, and West Virginia (the figure below shows the MTR area in the darkest shade). 

The authors only focused on chronic heart diseases, and they did not include cardiovascular problems that clearly result from something other than coal mining exposure.  They also accounted for the effects of other environmental factors on heart health, including smoking rates, adult obesity rates, and poverty levels.  Their results show that in mining areas poor socioeconomic and behavioral conditions lead to poor health and higher rates of death.  Even when controlling for these other risk factors, Esch and Hendryx found that cardiovascular related death rates remained high in MTR areas.  The study also shows that the rate of death goes up with the amount of surface mining being done in the area.

These results translate to an additional 703 deaths per year in the mountaintop removal areas and an additional 369 deaths per year in the other mining areas—a total of 1,072 extra deaths in mining areas.

Esch and Hendryx suggest a follow up study that looks at individuals living near mountaintop removal sites, as opposed to countywide data.



Hendryx, M., and L. Esch.  (2011) “Chronic Cardiovascular Disease Mortality in Mountaintop Mining Areas of Central Appalachian States.”  Journal of Rural Health.