Hendryx Michael, Ahern Melissa M
Department of Community Medicine, Institute for Health Policy Research, West Virginia University, Morgantown, WV 26506, USA.
Public Health Rep. 2009 Jul-Aug;124(4):541-50. doi: 10.1177/003335490912400411.
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.
The 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 3975 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 1736 to 2889, 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.
Research priorities to reduce Appalachian health disparities should focus on reducing disparities in the coalfields. The human cost of the Appalachian coal mining economy outweighs its economic benefits.
我们研究了1979 - 2005年阿巴拉契亚煤矿区升高的死亡率，并估计了相对于煤矿行业经济效益而言损失的统计生命价值（VSL）。
我们比较了四个县组的年龄调整死亡率和社会经济状况：煤矿开采水平高的阿巴拉契亚地区、煤矿开采水平较低的阿巴拉契亚地区、无煤矿开采的阿巴拉契亚地区以及美国其他县。我们将死亡率估计值转换为VSL估计值，并将结果与煤矿开采的经济贡献进行比较。我们还进行了贴现分析，以估计相对于未来死亡成本的当前收益。
阿巴拉契亚煤矿开采最密集的地区社会经济状况最差。在调整协变量之前，根据所研究的年份和比较组，煤矿区每年年龄调整后的超额死亡人数在3975至10923人之间。相应的VSL估计值在185.63亿美元至845.44亿美元之间，点估计值为500.10亿美元，高于煤矿开采80.88亿美元的经济贡献。调整协变量后，矿区每年的超额死亡人数在1736至2889人之间，VSL成本继续超过开采收益。将VSL成本贴现到未来，在八种情况中的七种情况下，成本相对于收益出现超额，点估计值为418.46亿美元。
减少阿巴拉契亚地区健康差距的研究重点应集中在减少煤田地区的差距。阿巴拉契亚煤矿经济的人力成本超过了其经济效益。
