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 7264 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