Hospitalization patterns associated with Appalachian coal mining.

The goal of this study was to test whether the volume of coal mining was related to population hospitalization risk for diseases postulated to be sensitive or insensitive to coal mining by-products. The study was a retrospective analysis of 2001 adult hospitalization data (n = 93,952) for West Virginia, Kentucky, and Pennsylvania, merged with county-level coal production figures. Hospitalization data were obtained from the Health Care Utilization Project National Inpatient Sample. Diagnoses postulated to be sensitive to coal mining by-product exposure were contrasted with diagnoses postulated to be insensitive to exposure. Data were analyzed using hierarchical nonlinear models, controlling for patient age, gender, insurance, comorbidities, hospital teaching status, county poverty, and county social capital. Controlling for covariates, the volume of coal mining was significantly related to hospitalization risk for two conditions postulated to be sensitive to exposure: hypertension and chronic obstructive pulmonary disease (COPD). The odds for a COPD hospitalization increased 1% for each 1462 tons of coal, and the odds for a hypertension hospitalization increased 1% for each 1873 tons of coal. Other conditions were not related to mining volume. Exposure to particulates or other pollutants generated by coal mining activities may be linked to increased risk of COPD and hypertension hospitalizations. Limitations in the data likely result in an underestimate of associations.