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Coal workers' pneumoconiosis in the United States: regional differences 40 years after implementation of the 1969 Federal Coal Mine Health and Safety Act
  1. Eva Suarthana1,2,
  2. A Scott Laney2,
  3. Eileen Storey2,
  4. Janet M Hale2,
  5. Michael D Attfield2
  1. 1Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
  1. Correspondence to Dr Eva Suarthana, Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, 1095 Willowdale Road, Room 2806, Morgantown, West Virginia 26505, USA; esuarthana{at}


Objective To assess whether the recent increases in the prevalence of coal workers' pneumoconiosis (CWP) in the USA reflect increased measured exposures over recent decades, and to identify other potential causative factors.

Methods The observed CWP prevalence was calculated for 12 408 underground coal miner participants in the Coal Workers' Health Surveillance Program for the period 2005–2009, stratified by the Mine Safety and Health Administration (MSHA) geographical districts. The predicted prevalence was estimated using a published exposure–response model from a large epidemiological study among US coal miners using dust exposure, tenure, miner's age and coal rank as predictors. χ2 Testing was performed to compare the observed versus predicted CWP prevalence.

Results Observed prevalence was significantly higher than predicted prevalence in MSHA districts 4–7 (central Appalachian region) (10.1% vs 4.2%; prevalence ratio (PR) 2.4; p<0.001) and significantly lower than predicted in other regions (1.6% vs 3.6%; PR 0.4; p<0.001). The central Appalachian region had a significantly older workforce with greater mining tenure, a lower proportion of mines with 200 or more employees, and lower seam heights. Significant lower average compliance dust concentrations were reported for this region.

Conclusion The observed CWP prevalence substantially exceeded predicted levels in central Appalachia. However, the increased prevalence was not explained by the measured levels of dust exposures. Likely contributing factors include mine size and low seam mining, which may be associated with higher exposure to silica. Further study is needed to characterise the responsible factors for the elevated CWP rates in central Appalachia.

  • Coal dust
  • epidemiology
  • health surveillance
  • pneumoconioses

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  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the National Institute for Occupational Safety and Health (NIOSH) Human Subjects Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.