Distribution of Coal Power, Pollution, and Poverty

Importance The adverse social exposome—life-course exposure to harmful social-environmental conditions—is associated with poor health outcomes. Exposure to heavy metals in air pollution from coal-fired power plants (CPP) may represent an underlying mechanism of this disparity, yet the association between the US adverse social exposome measured with the Area Deprivation Index (ADI) and CPP remains unknown. Objective To characterize the populations and adverse social exposome (indexed by ADI) of communities neighboring operational CPP. Design, Setting, and Participants Cross-sectional study of the US population using data from the 2023 Neighborhood Atlas. Data were analyzed from March to April 2026. Exposure Proximity to CPP was operationalized using 4 circular buffer zones: 3, 10, 25, and 50 miles in radius. Main Outcomes and Measures (1) Characterize each buffer zone by ADI and (2) determine the potential population-level exposure to CPP. Census block group delineations and population characteristics are from time-concordant US Census and American Community Survey data. Results The 2023 US population included 335 563 144 people (169 517 541 [50.5%] female, 66 294 296 [19.8%] Hispanic, 269 268 846 [80.2%] not Hispanic or Latino, and 212 002 396 [63.1%] White). A total of 2 783 004 people (0.83% of the US population) lived within 3 miles of a CPP. This group was more likely to live in the highest ADI neighborhoods as compared with the lowest ADI neighborhoods. Compared with the US population, these individuals were more likely to be American Indian and Alaska Native, White, and non-Hispanic. Populations living in the lowest 10% of ADI neighborhoods (most advantaged) had lower odds (odds ratio, 0.04; 95% CI, 0.00-0.81) of living within 3 miles of a CPP as compared with populations living in the highest 10% of ADI neighborhoods (most disadvantaged). Conclusions and Relevance In this cross-sectional study of US communities’ proximity to CPP, we found that neighborhoods potentially exposed to CPP’s hazardous environmental toxicants were more likely to be high ADI (ie, lower socioeconomic status) than low ADI (ie, higher socioeconomic status), highlighting the significantly greater burden of environmental toxicants potentially borne by disadvantaged US populations. Recent federal deregulations are likely to further increase these potential CPP-related toxin exposures. Additional study is needed to determine if these environmental toxicants trigger biological mechanisms underpinning the association between high ADI and poor health.