Healthcare utilization among Coal Miners: Interactive GIS Maps

There are 55 Black Lung clinics program in the US. Most of these clinics are in the Appalachian region (Figure 1).

There are 710 active mines in the US. Most of the active mines are in the Appalachian region (Figure 2).

Reference – United States Energy Information Administration, (2016). Coal Mines, Surface and Underground Layer. Retrieved from: https://www.eia.gov/maps/layer_info-m.php

There were 54,134 abandoned mines in the US. Counties in West Virginia, Kentucky, Ohio, Wyoming, Montana, Utah, Colorado and Alabama had relatively high concentration of abandoned mines compared to other counties in the country (Figure 3).

Reference -United States Office of Surface Mining Reclamation and Enforcement, (2018). Abandoned Mine Land Inventory System. Retrieved from: https://www.osmre.gov/programs/AMLIS.shtm


The annual rates of healthcare utilization by patients with CWP (ICD-9 CM 500) was relatively higher in counties in eastern Kentucky (106.4 per 10,000 in Leslie county – 143.8 in Martin county) and southwest Virginia (71.5 per 10,000 in the Tazewell county – 105.1 in the Dickerson county).This area also has a relatively high concentration of BL clinics (Figure 4).

The cluster-outlier analysis for rates of healthcare utilization by patients with CWP (ICD-9 CM 500) shows that counties with high rates of utilizations were clustered in the east of Kentucky and in the south of West Virginia and Virginia. Three counties in Illinois including Saline, Gallatin, Hardin and four counties in Kentucky including Union, Crittenden, Webster, and Hopkins formed a high-high cluster (Figure 5).

Furthermore, the cluster-outlier analysis for rates of healthcare utilization by patients with other related pneumoconiosis (ICD-9 CM 501 – 505) shows counties with high rates of utilization were clustered around counties with high rates of utilization in West Virginia, Ohio, Arkansas, Alabama, Texas, Louisiana, Utah, and Montana compared to other counties in the United States (Figure 5). Most of the counties in these states that formed high-high clusters for Other related pneumoconiosis did not have BL clinics (Figure 6).


The results of the cluster-outlier analysis for rates of healthcare utilization by patients with other related pneumoconiosis show counties with high rates of healthcare utilization were clustered near counties with high rates of healthcare utilization in West Virginia, Ohio, Arizona, Texas, Alabama, Utah, Montana, and Oregon compared to other counties (Figure 7).