Mortality Disparities in Appalachia Reassessment of Major Risk Factors

Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine (Impact Factor: 1.63). 02/2012; 54(2):146-56. DOI: 10.1097/JOM.0b013e318246f395
Source: PubMed


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


Available from: Jonathan Borak, Nov 24, 2014

  • Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 07/2012; 54(7):768-9; author reply 770-3. DOI:10.1097/JOM.0b013e318254622f · 1.63 Impact Factor

  • Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 07/2012; 54(7):770-3. DOI:10.1097/JOM.0b013e31825cb7c4 · 1.63 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose/Objectives: To explore the feasibility of rural home telemonitoring for patients with lung cancer. Design: Exploratory, descriptive, observational. Setting: Patient homes within a 75-mile radius of the study hospital in West Virginia. Sample: 10 patients hospitalized with lung cancer as a primary or secondary-related diagnosis. Methods: Data included referral and demographics, chart reviews, and clinical data collected using a HomMed telemonitor. Five patients received usual care after discharge; five had telemonitors set up at home for 14 days with daily phone calls for nurse coaching; mid- and end-study data were collected by phone and in homes through two months. Main Research Variables: Enrollment and retention characteristics, physiologic (e.g., temperature, pulse, blood pressure, weight, O2 saturation) and 10 symptom datapoints, patient and family telemonitor satisfaction. Findings: Of 45 referred patients, only 10 consented; 1 of 5 usual care and 3 of 5 monitored patients completed the entire study. Telemonitored data transmission was feasible in rural areas with high satisfaction; symptom data and physiologic data were inconsistent but characteristic of lung cancer. Conclusions: Challenges included environment, culture, technology, and overall enrollment and retention. Physiologic and symptom changes were important data for nurse coaching on risks, symptom management, and clinician contact. Implications for Nursing: Enrollment and retention in cancer research warrants additional study. Daily monitoring is feasible and important in risk assessment, but length of time to monitor signs and symptoms, which changed rapidly, is unclear. Symptom changes were useful as proxy indicators for physiologic changes, so risk outcomes may be assessable by phone for patient self-management coaching by nurses.
    Oncology Nursing Forum 03/2014; 41(2):153-61. DOI:10.1188/14.ONF.153-161 · 2.79 Impact Factor
Show more