Associations Between Surface Mining Airsheds and Birth Outcomes in Central Appalachia at Multiple Spatial Scales

A considerable body of research exists outlining ecological impacts of surface coal mining, but less work has explicitly focused on human health, and few studies have examined potential links between health and surface coal mining at fine spatial scales. In particular, relationships between individual birth outcomes and exposure to air contaminants from coal mining activities has received little attention. Central Appalachia (portions of Virginia, West Virginia, Kentucky, and Tennessee, USA), our study area, has a history of resource extraction, and epidemiologic research notes that the region experiences a greater level of adverse health outcomes compared to the rest of the country that are not fully explained by socioeconomic and behavioral factors. The purpose of this study is to examine associations between surface mining and birth outcomes at four spatial scales: individual, Census tract, county, and across county-sized grid cells. Notably, this study is among the first to examine these associations at the individual scale, providing a more direct measure of exposure and outcome. Airsheds were constructed for surface mines using an atmospheric trajectory model. We then implemented linear (birthweight) and logistic (preterm birth [PTB]) regression models to examine associations between airsheds and birth outcomes, which were geocoded to home address for individual analyses and then aggregated for areal unit analyses, while controlling for a number of demographic variables. This study found that surface mining airsheds are significantly associated with PTB and decreased birthweight at all four spatial scales, suggesting that surface coal mining activities impact birth outcomes via airborne contaminants. Plain Language Summary The human health impacts of surface coal mining are not well understood, particularly when considering the potential impacts on birth outcomes at the individual level. Central Appalachia, USA, which includes parts of Kentucky, Tennessee, Virginia, and West Virginia, has unexplained health concerns when compared to the rest of the country, and the region has a history of surface coal mining, making it an ideal study area to research these relationships. This research was conducted at the individual scale, as well as using Census tracts, county boundaries, and a large grid placed over the study area for comparison. Individual birth data including birthweight and length of gestation were received from each state's health department, along with characteristics of the mother including race/ethnicity and smoking status, so we could adjust for those factors. We estimated the movement of air contaminants from active surface mines, and then compared that exposure to birth outcomes using statistics. After adjusting for mother's characteristics, we found that preterm birth and decreased birthweight is associated with air moving from surface mines at all four spatial scales, suggesting that surface coal mining affects birth outcomes. Policy changes may help reduce the human health impacts of mining.