SOCIAL DETERMINANTS OF HEALTH IMPACTING OBESITY, DIABETES MELLITUS AND DEATH DUE TO INJURY IN WEST VIRGINIA AND VIRGINIA COAL COUNTIES

Meacham S, D Meisha, S Woolley, L Balmert, E Talbott, J Buchanich, A Snyder, Kennedy, KVia College of Osteopathic Medicine, Blacksburg, VAUniversity of Pittsburgh

2015 ENVIRONMENTAL CONSIDERATIONS IN ENERGY PRODUCTION September 22, 2015

Introduction• Recent publications have associated the environmental impacts

of mountain top coal mining in Appalachia with increased prevalence of chronic conditions such as obesity and comorbidities such as diabetes mellitus, heart diseases, cancers, and kidney diseases

• Our previous review and subsequent study findings on chronic health conditions in coal communities in Central Appalachia indicated regional differences in lifestyle behaviors and socio-demographic factors

• We anticipate that our work will lead to programs targeting specific geographic areas can benefit using evidence based knowledge to implement interventions with measureable goals to reduce localized and persistent rates of chronic diseases

Introduction (cont.)

• Investigators have identified a number of factors beyond coal important to health in coal mining communities• a need for improved access to care, education, cultural

sensitivity, understanding • managing multiple comorbidities • family inclusion in healthy lifestyle changes

Objective

The objective of this cross-sectional study was to identify distinguishing social determinants of health affecting obesity and diabetes in coal producing counties compared to non-coal producing counties in West Virginia and Virginia.

VA health districts and prevalence rates of adults with diabetes mellitus in 2005-2009 (VDH, BRFSS).

Rate of diabetes in the USA and VA from 1996-2009.

Percentage (%)

Virginia health districts and prevalence rates of obese adults. (BMI > 30) from 2007-2009 (VDH)

Map of Region

Figure 1: West Virginia and Virginia counties representing coal production and comparison counties identified for our previous study (Woolley et al., 2015). In the current study only West Virginia coal production counties (n=31, blue) and Virginia coal production counties (n=7, red) were included for analysis.  

Methods• Percent of obese and those with diabetes and

sociodemographic data on various factors were obtained from County Health Rankings (RWJF 2015) for the year 2012 for coal producing counties in West Virginia (n = 31) and Virginia (n = 7).

• Obesity was defined as BMI greater than or equal to 30kg/m2

• Diabetes was designated by all who answered, “yes,” to Has your doctor every told you that you have diabetes?”

• Death due to injury was a ‘control’, a non-chronic disease• Includes accidents, drowning, homicides, suicides, etc.

Methods• VDH –VCOM IRB approvals,

• Data management, age adjusted data

• Statistical methods: Paired t-test and Pearson correlation coefficients were employed for analyses

• Statistical significance was set, a priori, at p <0.05.

Methods2012 data was obtained from:

Health outcomes are determined by

- health behaviors (30%), - clinical care (20%), - social and economic factors

(40%), - physical environment (10%)

And, in turn, by the policies and programs.

Result Summary for WV - VA• Comparison of coal production and select health factors in

West Virginia and Virginia coal producing counties: • Coal production No • Diabetes mellitus No• Obesity Yes • Injury deaths No• Income No• Unemployment No• Poverty No• High School diploma Yes• Adult smoking No• Uninsured Yes• Over 65years old No

Results WV -VA

Variable

WV Coal Countiesa VA Coal Countiesb

Mean SD Mean SDP-

valuec

Coal production, 2012, thousand short tons, n=28

4297 4882 2709 2826 0.28

Diabetes, 2012, percent

13.29 1.79 12.29 0.76 0.16

Obesity, 2012, percentage 33.94 2.98 30.86 2.27 0.02d

Injury death, 2012, per 100,000 94.6 29.7 112.7 23.4 0.17aWV mean and standard deviations (SD), counties n=31, bVA counties n= 7; cP-values were for t-tests and equal variances were assumed except for coal production. dp < 0.05, significant differences between WV and VA coal counties.

Results WV - VA

Variable

WV Coal Countiesa VA Coal Countiesb

Mean SD Mean SD P-valuec

Population, 2012, n=28 39803 36291 28731 12104 0.44Per capita income, 2012, $ 32364 5096 31523 2592 0.68Unemployment, 2012, percentage

8.35 2.09 7.94 0.87 0.62

Poverty average, percent, 2008-2012 19.45 3.87 20.8 3.87 0.47

High school diploma average, percent, 2008 – 2012

79.90 6.93 73.0 4.69 0.02d

Results WV - VA

Variable

WV Coal Countiesa VA Coal Countiesb

Mean SD Mean SD P-valuec

Age, >65 years, 2012, percent 17.47 2.07 17.51 1.39 0.96

Rural, 2012, percent 67.46 24.36 80.39 21.49 0.20Annual health care cost/person, 2012, dollars

9958 1121 10864 972 0.06

Uninsured, 2012, percent 18.9 1.8 16.29 0.49 0.001d

Adult smoking, 2012, percent (n=6) 26.8 5.46 27.7 4.7 0.71

Results WV -VA• Differences noted in WV and VA coal counties:

• higher obesity rate (%) WV 33.94 ± 3.0 vs VA 30.86 ± 2.27 (p=0.02)

• lower education (%) VA 73.0 ± 4.7 vs WV 79.9 ± 6.9 (p=0.02)

• higher uninsured (%) WV 18.9 ± 1.8 vs VA 16.29 ± 0.49 (p=0.001)

Results: Obesity correlated with Adult obesity (%) and (Variable)

Correlation coefficient P-value <

Per capita, income, 2012 -0.43 0.01

Unemployment, percent, 2012 0.43 0.01

Uninsured, 2012, percent 0.40 0.01

Adult smoking, 2012, percent 0.46 0.00

Diabetes, 20120, percent 0.53 0.01

Injury death, 2012, per 100,000 0.38 0.02

Results: Diabetes correlated withvariable Correlation

coefficientP-value <

High school diploma average, percent, 2008 – 2012 -0.37 0.02

Unemployment, percent, 2012 0.53 0.00

Adult smoking, 2012, percent 0.33 0.05

Injury death, 2012, per 100,000 0.50 0.01

Results: Injury Deaths correlated withInjury deaths,2012, per 100,000 and (Variable)

Correlation coefficient P-value <

Per capita, income, 2012 -0.32 0.05High school diploma average, percent, 2008 – 2012

-.0.75 0.00

Unemployment, percent, 2012 0.47 0.00Poverty average, percent, 2008-2012

0.54 0.00

Annual health care cost/person, 2012, dollars

0.45 0.01

Rural, 2012, percent 0.45 0.01Adult smoking, 2012, percent (n=6)

0.69 0.00

Conclusion• Health disparities present in coal production counties in

Virginia and West Virginia have persisted since data collection was initiated over half a century ago.

• Causative factors need to be further investigated, yet correlations are strongest and the most numerous when relating deaths due to injuries compared to chronic disease precursor conditions, obesity and diabetes.

Conclusion

• While both coal mining areas of WV and VA continue to have higher mortality rates relative to comparison counties, a striking finding was the poorer mortality outcomes in coal mining counties of VA.

Conclusion• Our findings add additional support to the recent focus on

mental health. • Attempts to improve chronic diseases in recent years may

be losing 'ground' to the troubling increases in mental health diagnoses.

• An interdisciplinary team of health care professionals may benefit from these findings when structuring interventions to improve health, mental and physical, in coal counties of WV and VA.

Ongoing Research: Healthy People 2020 and Cancer mortality

• Using “County Health Rankings” and the guidelines for Healthy People 2020 this study examines counties meeting the HP2020 goal for cancer mortality rates and compares those meeting the goal with those not meeting the goal

• Findings reveal that those meeting the HP2020 goal for cancer mortality rates have higher rates of smoking, physical inactivity, and obesity.

Ongoing Research: Cancer Mortality Rates in Medically Underserved Areas

• There is great overlap between the Medically Underserved regions of Virginia and those designated as Coal Mining counties

• In the Medically underserved regions, Lung cancer mortality rates are dropping at a slower rate than Non-Medically Underserved

• Data obtained from CDC and Virginia Department of Health

Thank you!Funding source: This study is sponsored by Initiative for Environmental Science (ARIES). ARIES is an industrial affiliates program at Virginia Tech, supported by members that include companies in the energy sector. The research under ARIES is conducted by independent researchers in accordance with the policies on scientific integrity of their institutions. The views, opinions and recommendations expressed herein are solely those of the authors and do not imply any endorsement by ARIES employees, other ARIES-affiliated researchers or industrial members. Information about ARIES can be found at http://www.energy.vt.edu/ARIES.”