Black Lung Disease Making a Comeback in the United States, Study Finds

Coal worker’s pneumoconiosis (CWP), commonly called black lung, is making a return, especially in central Appalachia, according to a recent study published in the American Journal of Public Health.

The study’s authors predicted current black lung prevalence estimates will likely worsen in terms of severe and disabling disease, including progressive massive fibrosis. They also said enhancement and enforcement of 2014 safety standards for coal workers remains critical for reversing the rising trend of this progressive disease.

This prevalence study examined x-rays from 1970 to 2017, looking for the presence of small opacities, with profusion greater than or equal to subcategory 1/0, or the presence of a large opacity larger than 1 centimeter.

Following a low point in the late 1990s, the national prevalence of black lung in miners working 25 years or more now exceeds 10%. In central Appalachia—Kentucky, Virginia, and West Virginia—the figure is 20.6%. When the study excluded miners from central Appalachia, the prevalence for the rest of the United States was lower, but an increase since 2000 remained clear.

“Although many consider black lung a disease of antiquity, it is undeniable that the responsible causative agent for these contemporary cases has resulted from injurious exposures encountered in the 21st century,” the authors wrote.

New standards were introduced in 2014 to protect coal miners, including lowering the allowable concentration of respirable dust in the mines, the authors wrote, but they noted that at the end of last year, the Trump administration filed a request for information soliciting public comment on existing standards and regulations.

“Although it is too early to assess the health impact of these recent primary and secondary prevention measures, we are not aware of any evidence of a decline in CWP, severe CWP, federal or state disability, compensation claims, or lung transplantation for CWP among miners in Appalachia,” the authors wrote.

Despite the increase in the disease, 1 state in Appalachia recently put a limit on the number of doctors who can decide about x-rays of workers filing for black lung compensation. NPR reported in March that the new law requires the disease to be diagnosed only by pulmonologists with a certain federal certification. There are just a handful of these specialists across the state and most work for coal companies. Before the law, radiologists had been allowed to diagnose the disease as well, the report said.

Reference

Blackley, DJ, Halldin, CN, Laney, AS. Continued increase in prevalence of coal workers’ pneumoconiosis in the United States, 1970—2017. [published online ahead of print July 19, 2018]. Am J Public Health. e1—e3. Doi: 10.2105/AJPH.2018.304517