Coal Tattoo

UPDATED:HERE’S today’s Gazette print story about this study.

As noted last night in Coal Tattoo’s comments section, a Yale University researcher hired by the National Mining Association has published the first peer-reviewed paper that offers a response to the 20 papers that West Virginia University’s Michael Hendryx has produced over the last four years exploring the links between living near mountaintop removal mines and facing increased risks of health problems, including cancer and birth defects.

The paper, by Dr. Jonathan Borak and others, is called “Mortality Disparities in Appalachia: Reassessment of Major Risk Factors.”  It’s published in this month’s Journal of Occupational and Environmental Medicine, with its abstract available for free here. As frequent Coal Tattoo reader and commenter Casey pointed out, the industry consulting group Environmental Resources Management Consulting has helpfully posted the entire paper on its company website.

Here’s the abstract, which describes the study’s objective, methods, results and conclusions:

Objective: To determine the predictive value of coal mining and other risk factors for explaining disproportionately high mortality rates across Appalachia.

Method: Mortality and covariate data were obtained from publicly available databases for 2000 to 2004. Analysis employed ordinary least square multiple linear regression with age-adjusted mortality as the dependent variable.

Results: Age-adjusted all-cause mortality was independently related to Poverty Rate, Median Household Income, Percent High School Graduates, Rural–Urban Location, Obesity, Sex, and Race/Ethnicity, but not Unemployment Rate, Percent Uninsured, Percent College Graduates, Physician Supply, Smoking, Diabetes, or Coal Mining.

Conclusions: Coal mining is not per se an independent risk factor for increased mortality in Appalachia. Nevertheless, our results underscore the substantial economic and cultural disadvantages that adversely impact health in Appalachia, especially in the coal-mining areas of Central Appalachia.

Now, we’ve yet to hear anything from the National Mining Association trumpeting the findings. I have to express some shock that it hasn’t shown up on West Virginia MetroNews or in the Daily Mail yet. Maybe the NMA has learned from its previous problems attacking Dr. Hendryx, like the time the industry’s law firm tried to suggest that any increased rate of birth defects in Appalachia was caused by inbreeding.

Some readers may recall that about two years ago, the industry lobby went kind of crazy about a preliminary analysis that Dr. Borak did for them, with the NMA’s PR outfit “tweeting”:

Yale professor debunks bogus studies on the health effects of Appalachian surface mining.

When asked about it, Dr. Borak said his studies did no such thing and that he had never referred to the work by WVU’s Hendryx as “bogus.” The National Mining Association retreated, and apologized for its PR tactics.

Now, it’s important to note that this paper by Dr. Borak was peer-reviewed, and it’s published in a respected journal. That’s the way science is supposed to work. And the Borak paper is up-front about who funded it, saying right on the first page:

The study was supported by the National Mining Association.

It also says:

Its results presented here represent the conclusions and opinions solely of the authors. Its publication does not imply endorsements by the National Mining Association. The study sponsor had no role in the study design, analysis or interpretation of the data, or in the writing, preparation, or submission of the manuscript, which was not provided to the sponsors prior to its submission for publication.

So what does it say? Well, here’s some from the beginning, where Dr. Borak and his co-authors explain what they set out to do:

A recent series of ecological studies by researchers at West Virginia University (WVU) has suggested that age-adjusted Appalachian county mortality rates are independently related to the presence of coal mining, but the nature of that relationship was uncertain. Increased mortality rates were apparently not due to occupational exposures and observed mortality patterns differed between Appalachian coal-mining counties and coal-mining counties outside Appalachia. For example, county-level lung cancer mortality was elevated in Appalachian, but not in non-Appalachian coal mining areas. The WVU authors proposed that observed health disparities in residents of Appalachian mining areas might be attributed to a “coal mining–dependent economy,” or to “pollution” and the “environmental impacts of Appalachian mining,” or to “additional behavioral or demographic characteristics not captured through other covariates.”

To better understand these possibilities, particularly the role of coal mining as an independent risk factor for disparate mortality rates, we undertook a reanalysis of those published studies. Our objective was to determine the predictive value of coal mining and other potentially relevant risk factors for explaining differences in mortality rates across the Appalachian region.

And here’s the basis summary of what they found in two different model runs:

— These findings indicate that higher age-adjusted all-cause mortality rate was independently related to Poverty Rate, Percent High School Graduates, Rural–Urban Location, and Demographic variables including Sex and Race/Ethnicity rates. Mortality Rate was not significantly related to Percent College Graduates, Physician Supply, or Smoking Rate.


These findings indicate that higher age-adjusted all-cause mortality rate was independently related to Poverty Rate, Median Household Income, Percent High School Graduates, Rural–Urban Location, Obesity Rate, and Demographic variables including Sex and Race/Ethnicity rates. The relationship between Mortality Rate and Percent College Graduates was nearly significant (P = 0.0814), but Mortality Rate was not significantly related to Physician Supply, Smoking Rate, or Coal Mining: Yes/No.

And further analysis found:

… We considered the effects of including either of the twomeasures of coal mining in the Further ExpandedModel. Neither Coal Mining:Yes/No nor Coal Mining: High/Low/None significantly improved the explanatory power of the model. The findings of this analytical model argue that coal mining is not per se an independent risk factor for increased mortality in Appalachia. By contrast, we found that increased mortality was significantly associated with greater poverty, lower median household income, fewer high school graduates, rural location, obesity rate, and demographic factors including sex and race. Lower college graduate rate was nearly significant. Moreover, we found no significant associations for smoking, physician supply, and diabetes.

And here’s how they explained the differing results concerning coal mining’s impacts:

The WVU studies each defined different coal-mining categories. One defined coal-mining areas as “counties with any amount of coal mining” during 1994 to 2005; some analyses also grouped coal-mining counties into those above and below the median production level. A second study defined three groups of counties based on total 2000 to 2004 coal production: more than 3 million tons; less than 3 million tons; and no production. For some analyses, counties with more than 3 million tons of production were compared with all other counties combined and “per capita coal production” (calculated relative to the 2000 census) was also included in those analysis. The third study also defined three groups of counties on the basis of total 2000 to 2004 coal production, but groups were defined differently: more than 4 million tons; less than 4 million tons; and no production. Our approach was similar to the first of those WVU studies, but we considered the time span considered in the latter two studies. Our analysis divided counties into two groups based on whether any amount of coal was mined during 2000 to 2004, and coal-producing counties were further grouped into those above and below the median production level for Appalachian counties during that time period.

Our Expanded Model indicates that coal mining is not per se the cause of increased mortality in rural Appalachia. On the contrary, our results underscore the substantial economic and cultural disadvantages that adversely impact the health of many area residents. Particularly in the coal-mining areas of central Appalachia, there is a potent combination of greater economic distress, lesser educational attainment, decreased access to health care, limited availability of nutritious foods, higher rates of behavior-related risks such as obesity and smoking, and decreased use of preventive health services.

But here’s where things start to get more interesting:

Such overlapping risk factors and mortality rates illustrate how difficult it can be to disentangle the effects of the cultural environment from those of the physical environment, a difficulty made greater because the two interact. For example, the physical isolation of the mountainous counties that characterize rural Appalachia poses barriers to industrial diversification and broadening of employment options, and also contributes to lower incomes, reduced access to health care services, reduced availability of nutritious foods, and so forth. The interplay of geographical isolation,
kinship, and health-related behaviors further complicates matters. Rural Appalachia is distinguished by tight-knit social networks, “cohesive, extended, and geographically connected” kinships, which often extend beyond biological families. Such networks can exert significant influence on the behaviors and health of their individual members, as recently documented in the Framingham Study. In that well-studied New England community, risks of becoming obese (ie, the “induction and person-to-person spread of obesity”) were predicted by the closeness of social relationships, not by “common exposure to the local environment.” Thus, the physical environment (eg, geographical isolation) can foster cultural practices (eg, tightknit kinships) that promote adverse health outcomes (eg, obesity).

The authors continued:

Accordingly, coal mining in Appalachia, an industrial activity associated with rural, mountainous areas, is likely to be geographically associated with a variety of economic and cultural health risk factors. And, for similar reasons, mining is also likely to be geographically associated with a variety of adverse health outcomes. Although our results indicate that mining is not the direct cause of those outcomes, they do not rule out the possibility that mining contributes to the development of the social environments and cultural practices that adversely impact health.

And here’s the kicker:

This possibility seems most likely in those specific areas where mining is the principal industry. Likewise, our analyses do not rule out the possibility that some specific mining methods may have greater adverse effects than others on the physical environment.

Finally, they conclude:

Ultimately, the issue of greatest concern is that Appalachians suffer disproportionately poor health and increased risks of adverse health outcomes compared with the rest of the nation. During the past 50 years, ARC and others have overseen substantial improvements in the well-being of regional residents. Nevertheless, significant shortfalls persist. To eliminate health-related disparities, substantial efforts must be directed at the region’s underlying economic
and social disparities. To the extent that coal mining is factor in defining the cultural fabric and socioeconomic environment of Appalachian communities, the coal-mining industry must play a role in efforts to increase economic diversity, develop job-creation programs, ensure access to appropriate heath care services, improve educational opportunities, and facilitate access to nutritious foods and diets.

My friend Andrew Revkin, who does the DotEarth blog, has often written and talked about the “whiplash” effect of media coverage of scientific papers about global warming and other important public policy debates:

Unfortunately, when research on tough questions sits under the microscope because of its relevancy to policy fights, the impact on the public can be a severe case of whiplash. Journalists and campaigners succumbing to “single-study syndrome” in search of a hot front-page headline or debating point threaten to alienate readers seeking some sense of reality.

Environmental groups, coalfield citizens — human rights activists to use the term some of them prefer — have been sometimes over the top in their description of what Dr. Michael Hendryx has found (see the comments section here).  Is there any doubt that the coal industry hasn’t, well, exactly acted very honorably, in terms of trying to distort things and pollute the public discourse over what is clearly an important issue?

Personally, I’m hoping to soon get an email or a call back from Dr. Borak to talk to him about his paper. I’m hoping to get Dr. Hendryx on the phone to get his response, and I hope to soon reach a few independent public health experts who can give me their views on the matter. As I wrote earlier today in response to Casey’s comment:

… These findings do absolutely nothing to diminish the need for public officials in the region to pay attention to this scientific discussion. It would be great if Sen. Rockefeller held a hearing and invited Dr. Hendryx and Dr. Borak to testify about their work, explain the differences and the implications, and help educate the public and policymakers on what all of this means.

What the coal industry wants right now is for the scientists they fund to churn out papers that they can use in a PR effort to discredit the work of Dr. Hendryx. what citizen groups want is to discredit those industry-funded papers.

Those interests are quite different from the needs of the actual public. What the public needs is for policymakers and the media to work on helping them understand what the science means and what sorts of public policies it suggests be followed.