Heavy rains at night caused severe flooding in eastern Kentucky on 28 July 2022, resulting in 39 deaths. Using publicly available information, we assembled a database of these fatalities, including demographic characteristics and location of death. We perturbed fatality locations and plotted them on a topographical map highlighting mountaintop removal mining with valley fill sites, where mountaintops were excavated to mine thin seams of coal. This map reveals many flood fatalities occurred along rivers or streams near such sites. Previous research suggests that surface mining has contributed to the majority of land cover change in this region, and this has increased storm water runoff. The legacy of coal mining in Central Appalachia could thus present immediate challenges to public health and safety beyond more frequently studied health outcomes associated with occupational and environmental exposures. A review of prior surface mining legislation to assess its effectiveness is warranted.

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