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Title: Higher coronary heart disease and heart attack morbidity in Appalachian coal mining regions

Abstract

This study analyzes the U.S. 2006 Behavioral Risk Factor Surveillance System survey data (N = 235,783) to test whether self-reported cardiovascular disease rates are higher in Appalachian coal mining counties compared to other counties after control for other risks. Dependent variables include self-reported measures of ever (1) being diagnosed with cardiovascular disease (CVD) or with a specific form of CVD including (2) stroke, (3) heart attack, or (4) angina or coronary heart disease (CHD). Independent variables included coal mining, smoking, BMI, drinking, physician supply, diabetes co-morbidity, age, race/ethnicity, education, income, and others. SUDAAN Multilog models were estimated, and odds ratios tested for coal mining effects. After control for covariates, people in Appalachian coal mining areas reported significantly higher risk of CVD (OR = 1.22, 95% CI = 1.14-1.30), angina or CHO (OR = 1.29, 95% C1 = 1.19-1.39) and heart attack (OR = 1.19, 95% C1 = 1.10-1.30). Effects were present for both men and women. Cardiovascular diseases have been linked to both air and water contamination in ways consistent with toxicants found in coal and coal processing. Future research is indicated to assess air and water quality in coal mining communities in Appalachia, with corresponding environmental programs and standardsmore » established as indicated.« less

Authors:
;  [1]
  1. West Virginia University, Morgantown, WV (United States). Dept. of Community Medicine
Publication Date:
OSTI Identifier:
21261721
Resource Type:
Journal Article
Resource Relation:
Journal Name: Preventive Medicine; Journal Volume: 49; Journal Issue: 5
Country of Publication:
United States
Language:
English
Subject:
01 COAL, LIGNITE, AND PEAT; PUBLIC HEALTH; COAL MINERS; HEART; DISEASES; DISEASE INCIDENCE; APPALACHIAN MOUNTAINS; USA; COAL MINING; TOBACCO SMOKES; WATER POLLUTION; AIR POLLUTION; COAL PREPARATION

Citation Formats

Hendryx, M., and Zullig, K.J. Higher coronary heart disease and heart attack morbidity in Appalachian coal mining regions. United States: N. p., 2009. Web. doi:10.1016/j.ypmed.2009.09.011.
Hendryx, M., & Zullig, K.J. Higher coronary heart disease and heart attack morbidity in Appalachian coal mining regions. United States. doi:10.1016/j.ypmed.2009.09.011.
Hendryx, M., and Zullig, K.J. 2009. "Higher coronary heart disease and heart attack morbidity in Appalachian coal mining regions". United States. doi:10.1016/j.ypmed.2009.09.011.
@article{osti_21261721,
title = {Higher coronary heart disease and heart attack morbidity in Appalachian coal mining regions},
author = {Hendryx, M. and Zullig, K.J.},
abstractNote = {This study analyzes the U.S. 2006 Behavioral Risk Factor Surveillance System survey data (N = 235,783) to test whether self-reported cardiovascular disease rates are higher in Appalachian coal mining counties compared to other counties after control for other risks. Dependent variables include self-reported measures of ever (1) being diagnosed with cardiovascular disease (CVD) or with a specific form of CVD including (2) stroke, (3) heart attack, or (4) angina or coronary heart disease (CHD). Independent variables included coal mining, smoking, BMI, drinking, physician supply, diabetes co-morbidity, age, race/ethnicity, education, income, and others. SUDAAN Multilog models were estimated, and odds ratios tested for coal mining effects. After control for covariates, people in Appalachian coal mining areas reported significantly higher risk of CVD (OR = 1.22, 95% CI = 1.14-1.30), angina or CHO (OR = 1.29, 95% C1 = 1.19-1.39) and heart attack (OR = 1.19, 95% C1 = 1.10-1.30). Effects were present for both men and women. Cardiovascular diseases have been linked to both air and water contamination in ways consistent with toxicants found in coal and coal processing. Future research is indicated to assess air and water quality in coal mining communities in Appalachia, with corresponding environmental programs and standards established as indicated.},
doi = {10.1016/j.ypmed.2009.09.011},
journal = {Preventive Medicine},
number = 5,
volume = 49,
place = {United States},
year = 2009,
month =
}
  • We examined elevated mortality rates in Appalachian coal mining areas for 1979-2005, and estimated the corresponding value of statistical life (VSL) lost relative to the economic benefits of the coal mining industry. We compared age-adjusted mortality rates and socioeconomic conditions across four county groups: Appalachia with high levels of coal mining, Appalachia with lower mining levels, Appalachia without coal mining, and other counties in the nation. We converted mortality estimates to VSL estimates and compared the results with the economic contribution of coal mining. We also conducted a discount analysis to estimate current benefits relative to future mortality costs. Themore » heaviest coal mining areas of Appalachia had the poorest socioeconomic conditions. Before adjusting for covariates, the number of excess annual age-adjusted deaths in coal mining areas ranged from 3,975 to 10,923, depending on years studied and comparison group. Corresponding VSL estimates ranged from $18.563 billion to $84.544 billion, with a point estimate of $50.010 billion, greater than the $8.088 billion economic contribution of coal mining. After adjusting for covariates, the number of excess annual deaths in mining areas ranged from 1,736 to 2,889, and VSL costs continued to exceed the benefits of mining. Discounting VSL costs into the future resulted in excess costs relative to benefits in seven of eight conditions, with a point estimate of $41.846 billion.« less
  • The purpose of this study was to assess the cardiac side effects, primarily the occurrence of ischemic heart disease, in symptom-free patients with early breast cancer treated with radiotherapy. Thirty-seven survivors of a former randomized study of early breast cancer were examined. Twenty patients irradiated pre- or postoperatively for left sided disease (study group patients) were compared with 17 controls who were either treated for right sided disease, or were nonirradiated patients. Radiotherapy was randomized in the original study; either tangential field [sup 60]Co, or electron-therapy was delivered. Echocardiography and bicycle ergometry stress test with [sup 99m]Tc SestaMIBI myocardial perfusionmore » scintigraphy were carried out and the patients' major risk factors for ischemic heart disease were also listed. Our results showed a significant difference between the scintigraphic findings of the two groups. Five of the 20 study group patients (25%), while none of the 17 controls exhibited some kind of significant defects on scintigraphy, indicating ischemic heart disease (p < 0.05). No deterioration in left ventricular systolic and/or diastolic function could be detected by echocardiography. Radiotherapy for left sided breast cancer with the mentioned treatment technique may present as an independent risk factor in the long-term development of ischemic heart disease, while left ventricular dysfunction could not be related to the previous irradiation. The authors emphasize the need to optimize adjuvant radiotherapy for early breast cancer by considering the dose both to the heart as well as the cancer. 39 refs., 4 tabs.« less
  • The detection of regional asynergy provides strong evidence for a critical reduction of coronary blood flow to that zone. In the present study, the usefulness of combining computer-assisted radionuclide angiography and isometric handgrip exercise testing to detect coronary heart disease (CHD) was evaluated. One hundred twenty-nine patients with chest pain undergoing cardiac catheterization were evaluated using radionuclide angiography. Thirty-four patients were found to have severe contraction abnormalities during the initial radionuclide angiographic study. Of these, 33 had significant CHD. Ninety-five patients had normal or borderline normal left ventricular contraction and therefore underwent a second radionuclide angiogram during handgrip. Radionuclide angiogrammore » data were quantitatively analyzed by computer to determine regional left ventricular contribution to ejection fraction during handgrip stress. Of the 95 patients, 30 had normal coronary arteries of whom 26 (87%) had normal relative regional ejection fraction. Sixty-five patients had CHD; 20 had single and 45 had two or three vessel obstructive disease. Overall, of the 95 patients who underwent isometric handgrip stress, sensitivity was 86% for detection of CHD and specificity was 87% for accurately defining the patients with normal coronary arteries. The results of the present study suggest that the radionuclide angiographic assessment of relative regional ejection fraction during isometric handgrip exercise may provide a useful new diagnostic approach for patients with suspected CHD as well as providing important additional data concerning its location and severity.« less
  • Purpose: To prospectively investigate the coronary artery status using coronary CT angiography (CCTA) in patients with Hodgkin lymphoma treated with combined modalities and mediastinal irradiation. Methods and Materials: All consecutive asymptomatic patients with Hodgkin lymphoma entered the study during follow-up, from August 2007 to May 2012. Coronary CT angiography was performed, and risk factors were recorded along with leukocyte telomere length (LTL) measurements. Results: One hundred seventy-nine patients entered the 5-year study. The median follow-up was 11.6 years (range, 2.1-40.2 years), and the median interval between treatment and the CCTA was 9.5 years (range, 0.5-40 years). Coronary artery abnormalities were demonstrated in 46 patientsmore » (26%). Coronary CT angiography abnormalities were detected in nearly 15% of the patients within the first 5 years after treatment. A significant increase (34%) occurred 10 years after treatment (P=.05). Stenoses were mostly nonostial. Severe stenoses were observed in 12 (6.7%) of the patients, entailing surgery with either angioplasty with stent placement or bypass grafting in 10 of them (5.5%). A multivariate analysis demonstrated that age at treatment, hypertension, and hypercholesterolemia, as well as radiation dose to the coronary artery origins, were prognostic factors. In the group of patients with LTL measurements, hypertension and LTL were the only independent risk factors. Conclusions: The findings suggest that CCTA can identify asymptomatic individuals at risk of acute coronary artery disease who might require either preventive or curative measures. Conventional risk factors and the radiation dose to coronary artery origins were independent prognostic factors. The prognostic value of LTL needs further investigation.« less