Increased Dementia Mortality in West Virginia Counties with Mountaintop Removal Mining?

Atmospheric particulate matter (PM) is elevated in areas of mountaintop removal mining (MTM), a practice that has been ongoing in some counties of West Virginia (WV) USA since the 1970s. PM inhalation has been linked to central nervous system pathophysiology, including cognitive decline and dementia. Here we compared county dementia mortality statistics in MTM vs. non-MTM WV counties over a period spanning 2001-2015. We found significantly elevated age-adjusted vascular or unspecified dementia mortality/100,000 population in WV MTM counties where, after adjusting for socioeconomic variables, dementia mortality was 15.60 (±3.14 Standard Error of the Mean (S.E.M.)) times higher than that of non-MTM counties. Further analyses with satellite imaging data revealed a highly significant positive correlation between the number of distinct mining sites vs. both mean and cumulative vascular and unspecified dementia mortality over the 15 year period. This was in contrast to finding only a weak relationship between dementia mortality rates and the overall square kilometers mined. No effect of living in an MTM county was found for the rate of Alzheimer's type dementia and possible reasons for this are considered. Based on these results, and the current literature, we hypothesize that inhalation of PM associated with MTM contributes to dementia mortality of the vascular or unspecified types. However, limitations inherent in ecological-type studies such as this, preclude definitive extrapolation to individuals in MTM-counties at this time. We hope these findings will inspire follow-up cohort and case-controlled type studies to determine if specific causative factors associated with living near MTM can be identified. Given the need for caregiving and medical support, increased dementia mortality of the magnitude seen here could, unfortunately, place great demands upon MTM county public health resources in the future.