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Evaluation of high blood pressure and obesity among US coal miners participating in the Enhanced Coal Workers’ Health Surveillance Program

https://doi.org/10.1016/j.jash.2017.06.007Get rights and content

Highlights

  • Prevalence of blood pressure in the hypertensive range was 60% higher than US population.

  • The prevalence of obesity was 52% higher than the US population.

  • Obesity and high blood pressure prevalence in these coal miners are substantial.

  • There is a need for cardiovascular health interventions in coal mining communities.

  • Mobile occupational health programs can identify miners with higher cardiovascular risk.

Abstract

Since 2005, the Enhanced Coal Workers’ Health Surveillance Program (ECWHSP) has offered respiratory examinations to coal miners in a mobile examination unit. As little is known about the cardiovascular health of coal miners, we describe the prevalence of high blood pressure (BP) and obesity among ECWHSP participants. During 2015, 1402 ECWHSP health examinations were performed. The prevalence of BP consistent with hypertension (systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg), prehypertension (systolic BP 120–139 mm Hg or diastolic BP 80–89 mm Hg), and hypertensive crisis (systolic BP ≥ 180 mm Hg or diastolic BP ≥ 110 mm Hg) were calculated and compared with the US adult population using standardized morbidity ratios (SMRs). Most participants were male (N = 1317, 94%), White (N = 1303, 93%) and non-Hispanic (N = 1316, 94%). Thirty-one percent (N = 440) of participants had BP in the hypertensive range and 87% (N = 1215) were overweight/obese. Twenty-four participants (2%) had a BP reading consistent with a hypertensive crisis. Prevalence of obesity (52%, SMR = 1.52, 95% confidence interval = 1.41–1.64) and BP consistent with hypertension (31%, SMR = 1.60, 95% confidence interval = 1.45–1.76) was higher than the US adult population.The prevalence of obesity and BP consistent with hypertension in this population of coal miners is substantial, indicating a need for cardiovascular health interventions in coal mining communities.

Introduction

Since 2005, the National Institute for Occupational Safety and Health has administered the Enhanced Coal Workers’ Health Surveillance Program (ECWHSP) which offers medical examinations to coal miners at no cost to themselves in a mobile examination unit that travels to coal mining regions throughout the country. Outreach has been primarily directed to active coal miners, but former miners have been invited in the past. Examinations are focused on the detection of radiographic and lung function abnormalities. Spirometry testing is performed along with radiographic examinations and occupational history questionnaires. To assess for contraindications to spirometric testing, blood pressure (BP) screening and a health history questionnaire are offered. A limited assessment of cardiovascular health risk factors, including hypertension and obesity, can be made using information gathered during these evaluations.

Hypertension is an important risk factor for cardiovascular disease and affects almost one-third of the US adult population.1 Cardiovascular disease is the leading cause of death in the United States with one of every three deaths caused by heart disease or stroke.2, 3 As the leading cause of preventable death in people aged 40–65 years, or before retirement age, cardiovascular disease can be caused or exacerbated by occupational exposures.3, 4 Mining-related risk factors for cardiovascular disease include particulate matter,5 carbon monoxide,6 noise,7 vibration,8 temperature extremes,9 and shift work.10 These occupational-related factors combined with personal risk factors can put miners at greater risk of poor cardiovascular health. One US-based study found that during 1997–2007, compared with other industrial sectors, workers in the mining sector had the highest rates of diagnosed hypertension.11 However, this estimate might not reflect the burden of disease among coal workers specifically. Most studies evaluating hypertension in coal miners have occurred outside of the United States.12, 13, 14

Using BP readings and body mass index (BMI) collected during ECWHSP encounters, we describe the prevalence of BP in the hypertensive range and obesity among coal miners participating in the ECWSHP. Early detection of these cardiovascular risk factors, with appropriate referral and follow-up, can lead to interventions to prevent stroke, heart attack, and other cardiovascular events.

Section snippets

Methods

In 2015, 1402 ECWHSP health examinations were performed in West Virginia, North Dakota, Montana, Wyoming, Colorado, Utah, Ohio, Virginia, and Kentucky. Health evaluations included occupational history and a selected health history to rule out contraindications for spirometry. Miners were asked if they have had any surgeries in the past 90 days, if they have ever had a stroke, if they have ever been told by a doctor that they had an aneurysm, if they are troubled by shortness of breath when

Results

A majority of the 1402 participants were male (94%), White (93%), and non-Hispanic (94%; Table 1). The median age was 54 years with a range of 15–88 years. Forty-six percent of participants had a blood pressure reading consistent with prehypertension and 31% had a reading consistent with hypertension. The prevalence of blood pressures consistent with prehypertension was higher among males compared with females (48% vs. 35%, P = .0244); there was not a significant statistical difference in the

Discussion

Studies of coal miners' health have traditionally focused on respiratory disease. We found that the prevalence of blood pressures in the hypertensive range and obesity among ECWHSP coal miners was higher than what would be expected for the US adult population. Nearly eight of every 10 coal miners evaluated by the ECWHSP had blood pressure readings indicating either prehypertension or hypertension and nearly nine of 10 were overweight or obese.

Few studies have focused specifically on

Acknowledgments

The authors wish to acknowledge the contribution of Janet Hale, the NIOSH Coal Workers' Health Surveillance Program staff and the miners who participated.

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    All authors have no conflict-of-interest or financial disclosures.

    The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health. Mention of product names does not imply endorsement by NIOSH/CDC.

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