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article imageStudy confirms spike in black lung disease in US coal miners

By Karen Graham     May 23, 2018 in Health
New research presented at the 2018 American Thoracic Society International Conference concluded that despite implementation of dust controls decades ago, progressive massive fibrosis (PMF) is increasing among US coal miners in Appalachia.
Epidemiologists at the National Institute for Occupational Safety and Health identified the largest cluster of advanced black lung disease ever reported, a cluster that was first uncovered by NPR nearly 18 months ago, reported Digital Journal in February this year,
Progressive massive fibrosis, the most severe form of black lung disease, has seen a dramatic rise among coal workers and especially younger workers in central Appalachian coal mining states, including 30 percent in West Virginia and 16 percent each in Kentucky and Virginia.
A slide from a presentation by the National Institute for Occupational Safety and Health shows the p...
A slide from a presentation by the National Institute for Occupational Safety and Health shows the progression from a healthy lung to advanced black lung disease.
Research presented at ATS meeting
The new findings represent the first-ever documentation of this spike and were presented by Kirsten Almberg, research assistant professor of environmental and occupational health sciences in the University of Illinois at Chicago School of Public Health, at the American Thoracic Society meeting in San Diego on May 22.
Almberg, and her colleague, Robert Cohen, combed through black lung benefits claims from 1970 through 2016, and of the 314,176 miners filing claims during this time period, they identified 4,679 cases of PMF. Over half the cases of PMF were filed after 1996.
"It's not that we're discovering a new disease. We're seeing a resurgence of a disease that should have been eradicated," said Cohen. "You know, it's something we should not be seeing ... at all and we're seeing thousands of cases still in the 21st century."
"So it is certainly not a blip. It's not just a small spike. It's kind of a relentless and increasing progression of the disease," Cohen added.
Corn, Jack, 1929-, Photographer (NARA record: 8464440)
NIOSH testing has been voluntary
For decades, the National Institute for Occupational Safety and Health (NIOSH) has run a black lung testing and surveillance program to track the occurrence of simple and advanced black lung in every coal region of the country. And this is all the data researchers had to rely on in documenting any reduction or rise in the number of cases of black lung.
To make things more difficult, the testing was on a voluntary basis and only included working miners. So it is easy to see how results of any research could have been skewered. NIOSH says that only about 40 percent of working miners ever volunteered to do the testing, and from 2011 to 2016, the agency identified only 99 cases of black lung nationwide.
This is when National Public Radio did its own survey of black lung clinics and healthcare providers and came up with 2,000 cases during the same time frame. This, in turn, prompted the NIOSH to study two black lung clinics in Kentucky and Virginia, where they found the biggest cluster yet of PMF cases.
There has been a spike in the number of younger working miners getting black lung disease.
There has been a spike in the number of younger working miners getting black lung disease.
Corn, Jack, 1929-, Photographer (NARA record: 8464440)
The magnitude of the problem
When legislation went into effect mandating control of dust levels in U.S. coal mines in the 1970's, there was a decline in the number of new cases of black lung disease. But in 2000, that all changed as the numbers began creeping upward. And the resurgence of the deadly PMF is particularly worrisome.
Another issue is that many miners do not file claims while they are still working, and do not participate in medical surveillance or evaluations simply because they may find out they have the disease. On top of this, the procedure for filing a claim for black lung benefits is actually difficult, and it may be years before any benefits are awarded, if at all.
"The miners affected appear to be working in smaller mines that may have less investment in dust reduction systems," Almberg said. "Due to changes in mining practices over time, mines today may produce higher levels of crystalline silica, which is more damaging to the lungs than coal dust, during coal extraction. And minors appear to be working longer hours and more days per week, leaving less time for their lungs to clear the dust that has been inhaled."
"More research is needed to determine the causes of this increase in disease, but what is clear is that miners in recent decades have been over-exposed to dust, and ways to reduce these exposures is much-needed," Almberg said.
More about Coal miners, black lung disease, progressive massive fibrosis, dust concentrations, Health
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