Objective: To determine whether mortality disparities in Appalachia are due to coal mining or other factors.
Methods: Unadjusted and covariate adjusted rate ratio models calculated total, all external, and all cancer mortality rates from 1960 to 2009 for cumulative total, surface, and underground coal production in coal-mining counties compared with non-coal-mining counties.
Results: No coal-related statistically significant elevations in total or all external mortality were found. Control for covariates attenuated rate ratios for all levels of coal mining. All forms of coal were statistically significant in the adjusted rate ratio models for all cancer mortality, with 4% to 6% excesses in the highest quartiles of production.
Conclusions: Total and all external mortalities do not seem to be related to coal production in Appalachia, but all cancer mortality should be further examined. Additional causes of death should also be considered.