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. Author manuscript; available in PMC: 2018 Oct 1.
Published in final edited form as: Environ Int. 2017 Jul 21;107:163–172. doi: 10.1016/j.envint.2017.07.002

Table 2.

Overview of 29 community health studies

Outcomes Populations Exposures Findings Publications Risk of Bias Rating*
Cardiopulmonary: diagnoses, hospitalizations, and symptoms 1 national study; 2 regional studies in WV, KY, PA, and IN; 3 in WV; 1 in KY, 1 in VA; (2000–2014) Coal production by county; MTR mining (present or absent); Appalachia or non- Appalachia area ; residence within 3 miles of active surface mine Associated with adverse cardiopulmonary outcomes in most studies 8 studies (Brink et al. 2014; Hendryx et al. 2007; Hendryx and Ahern 2008; Hendryx and Zullig 2009; Hendryx 2013; Hendryx and Entwhistle 2015; Hendryx and Luo 2015; Talbott et al. 2015) graphic file with name nihms894868t1.jpg
Cancer: hospitalization, self-reported, lung 1 regional study in WV, KY, and PA; 2 in KY; 2 in WV; (1995–2012) Coal production by county; MTR mining (present or absent) Not associated with cancer in most studies 5 studies (Christian et al. 2011; Hendryx et al. 2007; Hendryx and Ahern 2008; Hendryx et al. 2012b; Hendryx 2013) graphic file with name nihms894868t2.jpg
Reproductive: birth defects and low birth weight 1 regional study in WV, VA, TN, and KY; 2 in WV; (1996–2009) Coal production by county; MTR mining (present or absent) Associated with low birth weight and some birth defects, but not associated with birth defects after adjusting for hospital of birth 3 studies (M Ahern et al. 2011; MM Ahern et al. 2011; Lamm et al. 2015) graphic file with name nihms894868t3.jpg
Mortality: all-cause and specific causes 3 national studies; 5 regional studies in Appalachia, WV, VA, TN, KY, and NC; 2 in WV; 1 in KY; (1950–2014) Coal production by county, per capita, by type, by GIS distance; MTR mining (present or absent) Appalachia or non- Appalachia area Associated with mortality in most studies (varying by type). Mortality was also associated with Appalachia and poverty in general. 11 studies (Borak et al. 2012; Buchanich et al. 2014; Esch and Hendryx 2011; Hendryx et al. 2008; Hendryx 2009; Hendryx and Ahern 2009; Hendryx et al. 2010; Hendryx 2013; Hendryx and Holland 2016; Hitt and Hendryx 2010; Woolley et al. graphic file with name nihms894868t4.jpg
General Health Status: self-reported scales and serious illness 1 national study; 2 regional studies in WV, TN, NC, KY, and VA; 1 in WV; 1 in KY; (2000–2012) Coal production by county; MTR mining (present or absent); Appalachia or non- Appalachia area; number of mining facilities near residence Associated with poorer health status in most studies 5 studies (Hendryx and Ahern 2008; Hendryx 2013; Woolley et al. 2015b; Zullig and Hendryx 2010, 2011) graphic file with name nihms894868t5.jpg
*

Risk of bias for 3 key questions: 1) Did the study design or analysis account for important confounding and modifying variables?, 2) Can we be confident in the exposure characterization?, and 3) Can we be confident in the outcome assessment? Pie charts depict the percent of studies that were rated as (++, dark green) definitely low risk of bias, (+, light green) probably low risk of bias, (-, yellow) probably high risk of bias, or (--, red) definitely high risk of bias.