The burden of coal abandoned mine lands, community context, and severity and progression of type 2 diabetes in Pennsylvania

An extensive history of coal mining in Pennsylvania has left wide expanses of the state burdened with abandoned structures, contaminated streams, and ragged landscapes. These environmental exposures in communities can pose physical threats to human health and also contribute to the deterioration of communities along socioeconomic, social, and physical dimensions. Assessing contextual aspects of communities is important for public health, particularly for residents affected by their local environments, but has never been explored in places burdened with coal abandoned mine lands (AML).;In the first ecologic phase, AML burden was characterized by 10 different metrics generated from data in the Reclaimed Abandoned Mine Land Inventory System and examined in relation with three dimensions of community context created from U.S. Census 2000 data. Multiple linear regression was performed on the continuous outcomes socioeconomic deprivation and social disorganization, while polytomous logistic regression was conducted on the categorical physical disorder outcome. In the main analysis, consistent, adverse associations that increased along a gradient of exposure were found between socioeconomic deprivation and eight measures of AML burden; five generally protective relationships with social disorganization; but no associations with physical disorder.;The physical and social environments characterizing communities, particularly socioeconomic deprivation, can also influence individual health outcomes such as type 2 diabetes. Recent studies of communities with active coal mining characterized by economic disadvantage have suggested an association with increased morbidity such as cardiovascular disease and diabetes. In the second, multilevel phase, diabetes severity and progression as evaluated by glycated hemoglobin (HbA1c) measures from the Geisinger Electronic Health Record was examined in relation to AML burden variables in cross-sectional and longitudinal analyses. After adjustment for several individual-level potential confounders, several of the AML burden variables showed positive associations with HbA1c levels and change in HbA1c levels at the highest exposure categories.;Findings from this research have the potential to inform policies that prioritize reclamation in accordance with the greatest public health need by targeting communities with the greatest AML burden and worst socioeconomic deprivation. Moreover, this research may help to promote secondary prevention of diabetes more upstream along the disease continuum.