Chest
Volume 67, Issue 4, April 1975, Pages 417-421
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Clinical Investigations
Mortality from Heart Disease in Coal Miners

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A study of 3,726 Appalachian coal miners was undertaken to determine the standard mortality ratio (SMR) for heart disease and to ascertain the effect of smoking, excess weight, and the level of physical activity on deaths due to this cause. SMR’s were calculated for all forms of heart disease and also separately for ischemic heart disease. For heart disease as a whole, SMR’s of 73 for working and 104 for nonworking miners were obtained. It was found in both working and nonworking miners that obese smokers had the greatest risk of dying of heart disease (SMR’s of 142 and 144, respectively). In the nonsupervisory underground work categories of face, transportation, and maintenance, an increase of SMR was observed, with face having the lowest and maintenance workers having the highest SMR. Use of all men from seven Appalachian states vs all US men as a standard population tended to slightly reduce the calculated SMR’s.

Section snippets

METHODS

A cohort of 4,134 Appalachian coal miners was selected by the US Public Health Service in 1962-1963 for inclusion in a prevalence study of coal miners’ pneumoconiosis.2 Of the original cohort, 2,549 working miners out of a planned sample of 2,751 men, or 92.7 percent, and 1,177 ex-miners out of a planned sample of 1,397 men, or 84 percent, agreed to participate. Ex-miners are nonworking miners who have left the mines because of ill health, retirement, or for another occupation. The sampling

RESULTS

Table 1 gives a breakdown of standard mortality ratios (SMR's) for working and nonworking miners for all heart disease, ischemic heart disease, and for all causes of death. It can be seen that working miners have SMR's that are significantly below 100 for both heart disease categories and for all causes regardless of whether the base population is all men in the United States, all men in seven Appalachian states, or the miners themselves. Nonworking miners have SMR's which are at the average of

DISCUSSION

Higgins reported a SMR of 84 in England and Wales7 and 144 in the United States for coal miners dying from coronary heart disease.1 Our figure of a SMR of 73 for working miners is lower than that found in Great Britain. Higgins7 concluded that skinfold measurements of men with coronary disease suggest that they are slightly more obese than others. There also was a slightly higher proportion of exsmokers and a lower proportion of nonsmokers among the men with coronary disease. We found that

CONCLUSIONS

The following conclusions may be drawn from the analysis of these results:

  • 1

    Working coal miners have a reduced possibility of dying from either all heart disease or ischemic heart disease, while nonworking coal miners die at the average of the standard population.

  • 2

    Smoking increases the probability of dying from all heart disease in both working and nonworking coal miners. Smokers in the nonworking group have a significant excess of deaths due to heart disease.

  • 3

    Obesity alone does not cause

REFERENCES (9)

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  • WS Lainhart et al.

    Pneumoconiosis in Appalachian Bituminous Coal Miners. PHS Publication no. 2000

    (1969)
  • International Classification of Diseases, Adapted for Use in the United States (Rev 8)

    (1968)
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Manuscript received January 21, 1974; revision accepted September 18.

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