Hundreds of Cases of Black Lung Identified in Appalachia

A letter published by NIOSH researchers in the Feb. 6 issue of the Journal of the American Medical Association confirms 416 cases of progressive massive fibrosis, also known as complicated black lung disease, from 2013 through 2017 in three clinics in Appalachia. Scott Laney, an epidemiologist with NIOSH, told National Public Radio that the findings represent “the largest cluster of progressive massive fibrosis ever reported.”

The cluster was discovered in a region that encompasses parts of Virginia, West Virginia, and Kentucky.

Progressive massive fibrosis, the most severe form of black lung disease, was previously thought to be nearly eradicated due to improvements in working conditions in coal mines following implementation of the Federal Coal Mine Health and Safety Act of 1969. Between 1990 and 1999, NIOSH’s Coal Worker Health Surveillance Program identified just 31 unique cases of the disease, according to a December 2016 issue of the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

An earlier NPR investigation had uncovered hundreds of cases of progressive massive fibrosis in Kentucky, Virginia, Pennsylvania, and Ohio, and attributed the likely causes to longer work shifts and the mining of thinner coal seams.

According to NIOSH, In the last decade, over 10,000 miners have died of coal workers’ pneumoconiosis, or what is commonly called black lung disease.

Black lung disease, which is caused by inhaling coal mine dust, results in scarring of the lungs and emphysema, shortness of breath, disability, and premature death. While the prevalence of black lung disease had decreased by about 90% from 1969 to 1995 following the enactment of the Coal Mine Health and Safety Act, the downward trend of this disease in coal miners has stopped.

Since 1995, the prevalence of black lung cases has more than doubled. Many current underground miners (some as young as in their 30s) are developing severe and advanced cases. Identification of advanced cases among miners under age 50 is of particular concern, as they were exposed to coal-mine dust in the years after implementation of the disease prevention measures mandated by the 1969 federal legislation.

An increased risk of pneumoconiosis has also been associated with work in certain mining jobs, in smaller mines, in several geographic areas, and among contract miners.