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Black Lung Disease Resurges in Appalachian Coal Miners

Potera, Carol

AJN The American Journal of Nursing: April 2019 - Volume 119 - Issue 4 - p 14
doi: 10.1097/01.NAJ.0000554534.63115.c4
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Earlier detection and treatment are needed.

Carol Potera

Figure.

Figure.

The prevalence of coal workers’ pneumoconiosis (CWP), or black lung disease, among miners in the United States has dramatically increased since 2000, especially in central Appalachia. In miners who have worked for 25 or more years, the national prevalence of CWP is more than 10%, and the prevalence exceeds 5% for miners who have worked 20 to 24 years. But among long-working Appalachian coal miners during the most recent five-year period, CWP reached 20.6%, the highest recorded prevalence in 25 years.

To determine these rates, researchers used radiographs collected from 1970 to 2017 by the Coal Workers’ Health Surveillance Program (CWHSP) of the National Institute for Occupational Safety and Health (NIOSH). The main purpose of the CWHSP is the early detection of CWP in local miners, including progressive massive fibrosis (PMF), a severe and totally disabling form of CWP. The CWHSP offers coal miners free radiographs periodically, yet annual participation is just 30% to 40%.

The prevalence of CWP in Appalachian miners is four times higher than the national average, and for one in 20 long-tenured miners, their CWP will progress to PMF. “We can think of no other industry or workplace in the United States in which this would be considered acceptable,” write the researchers. The study, published in the September 2018 American Journal of Public Health, highlights that black lung is not a disease of antiquity but results from injurious exposures to coal miners today.

Although PMF was rarely seen in miners who participated in the CWHSP throughout the 1990s, in 2018, according to a JAMA research letter, PMF was detected in 416 of 11,200 coal miners tested, most of whom were white men living in Kentucky or Virginia who had worked in the mines for about 28 years. They were the largest cluster of PMF ever reported in the scientific literature.

Years of potential life lost due to CWP also increased from 8.1 to 12.6 from 1999 to 2016, reported the August 3, 2018, Morbidity and Mortality Weekly Report. Among all occupational deaths from CWP, 75% occurred in coal miners, and 68% of these miners were operators of mining machines. The ongoing premature deaths underscore the need for primary prevention by limiting coal dust exposure and for early disease detection and treatment.—Carol Potera

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REFERENCE

Blackley DJ, et al Am J Public Health 2018;108(9):1220-2; Blackley DJ, et al. JAMA 2018;319(5):500-1; Mazurek JM, et al MMWR Morb Mortal Wkly Rep 2018 67 30 819–24
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