Unintended consequences of the Clean Air Act: Mortality rates in Appalachian coal mining communities

The 1990 amendments to the US Clean Air Act (CAA) encouraged the growth of mountaintop removal (MTR) coal mining in Central Appalachia. This study tests the hypothesis that the amendments had unintended impacts on increasing mortality rates for populations living in these mining areas. We used a panel design to examine adjusted mortality rates for three groups (all-cause, respiratory cancer, and non-cancer respiratory disease) between 1968 and 2014 in 404 counties stratified by MTR and Appalachian/non-Appalachian status. The results showed significant interactions between MTR status and post-CAA period for all three mortality groups. These differences persisted after control for time, age, smoking rates, poverty, obesity, and physician supply. The MTR region in the post-CAA years experienced an excess of approximately 1200 adjusted deaths per year. Although the CAA has benefits, energy policies have in general focused on the combustion portion of the fossil fuel cycle. Other components of fossil fuel production (e.g. extraction, transport, and processing) should be considered in the comprehensive development of sustainable energy policy.