Resurgence of Black Lung Disease in Coal Miners

Kirsten Almberg, PhD, assistant professor, University of Illinois at Chicago

Kirsten Almberg, PhD

New research presented at the 2018 American Thoracic Society International Conference concluded that despite implementation of dust controls decades ago, progressive massive fibrosis is increasing among US coal miners.

Researchers analyzed US Department of Labor data collected from former coal miners that applied for benefits under the Federal Black Lung Program since its inception in 1970—2016. The beginning of the program coincides with the adoption of modern dust control measures in mites. Data were characterized by tenure, age and state of last employment.

Throughout the last 46 years, 4679 coal miners were found to have progressive massive fibrosis, with 50% (n = 2318) of the program applications submitted since 2000.

Lead author, Kirsten Almberg, PhD, assistant professor, University of Illinois at Chicago, said the findings were not surprising, as survey data published in 2014 by the National Institute of Occupational Safety and Health (NIOSH) showed an increase in progressive massive fibrosis after reaching a low in 2000. Additionally, nationwide black lung clinics reported an increasing number of cases.

“We were, however, surprised by the magnitude of the problem and are astounded by the fact that this disease appears to be resurging despite modern dust control regulations,” Almberg added. “This is history going in the wrong direction.”

Almberg’s study concluded that the percentage of miners with a determination of progressive massive fibrosis among those applying for Federal Black Lung Program benefits increased from 0% in 1972 to 8.3% in 2014.

A majority of the miners last worked in mines in West Virginia (28.4%), Kentucky (20.2%), Pennsylvania (20%) or Virginia (15.3%). States with the greatest increase in percentage of disease determinations were Kentucky (0% in 1972, 9% in 2014), Tennessee (0% in 1970, 10% in 2016), West Virginia (0% in 1972, 11% in 2016) and Virginia (12% in 2015), while the percentage of disease in the rest of the US remained under 2%.

The study is consistent with surveillance reports that indicate the highest rates of disease are in central Appalachian states of Virginia, West Virginia and Kentucky, and identifies a previously unrecognized increase in percentage of disease claims in Tennessee

“In general, the higher concentration of dust, the more days worked per week, and the more years worked, the greater the risk,” Almberg concluded. “It’s a classic dose-response relationship.”

The resurgence points to a need for focused research on and implementation of primary prevention like reducing coal mine dust exposures and for improved secondary prevention, including medical surveillance.

Authors said that recently enacted Mine Safety and Administration dust regulations should help reduce dust exposure in US coal mines and that coal mine operators and coal miners should be educated continuously about the harmful effects of coal mine dust exposure. Continuous personal dust monitors may provide an opportunity for minors to participate in real-time monitoring to proactively reduce excessive exposures.

Study limitations include that filing for black lung health benefits is voluntary and the exact proportion of eligible coal miners who do not file is unknown.

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