Close a Pit, Kill a Community: An Ecological Analysis of Coal Mining History and Deaths of Despair in England and Wales

Background
Deaths of despair (suicide, drug poisoning, alcohol-specific mortality) have been framed either as demand-side phenomena driven by social and economic dislocation or as driven by supply-side changes in access to harmful substances. We assess these explanations in England and Wales by testing whether deaths of despair are higher in places shaped by historical coal mining and whether any association persists beyond current deprivation.
Methods
We linked 2015-2023 mortality data for all 7,264 middle super output areas (MSOAs, units of census geography in England and Wales) to a four-level measure of coalfield exposure (none, last pit closed <1946; 1946-1979; ≥1980). Poisson generalised linear mixed-effects models estimated rate ratios with offsets for the at-risk population, adjusting for age, sex, and period. We (1) estimated the association between coalfield exposure and deaths of despair; (2) tested heterogeneity by cause and sex; and (3) evaluated whether associations remained after adjustment for area-level deprivation.
Results
Former coalfield MSOAs had higher rates of all three types of deaths of despair than non-mining areas. Associations were strongest for alcohol-specific and drug-poisoning mortality, and survived adjustment for socioeconomic deprivation, albeit attenuated. Associations with suicide were smaller and concentrated in areas with post-1979 closures. Patterns were broadly similar for men and women.
Conclusions
Findings align with demand-side interpretations: place-based legacies of deindustrialisation are associated with elevated mortality even after accounting for current deprivation, indicating complex structural pathways. Policies should pair clinical responses with place-focused regeneration, rebuilding social and economic infrastructure in historically industrial communities.