Epidemiological data on US coal miners' pneumoconiosis, 1960 to 1988

Coal miner participation in a job transfer program designed to prevent progression of pneumoconiosis, United States, 1986-2016

The Part 90 program was designed to prevent progression of pneumoconiosis in U.S. coal miners by establishing their right to transfer to a less dusty job in the mine. We calculated the proportion of Part 90-eligible miners who participated during 1986-2016, examined participation by region, and compared characteristics of miners by participation status. Of the 3,547 eligible miners, 14.4% exercised their Part 90 option. Miners working in states outside central Appalachia, and those with more severe pneumoconiosis, were more likely to participate. The primary goal of respiratory health surveillance of coal miners is early detection of disease so that preventive action can be taken. Future studies should seek to better understand factors influencing Part 90 program participation.

Respiratory disease mortality among US coal miners; results after 37 years of follow-up

OBJECTIVES

To evaluate respiratory related mortality among underground coal miners after 37 years of follow-up.

METHODS

Underlying cause of death for 9033 underground coal miners from 31 US mines enrolled between 1969 and 1971 was evaluated with life table analysis. Cox proportional hazards models were fitted to evaluate the exposure-response relationships between cumulative exposure to coal mine dust and respirable silica and mortality from pneumoconiosis, chronic obstructive pulmonary disease (COPD) and lung cancer.

RESULTS

Excess mortality was observed for pneumoconiosis (SMR=79.70, 95% CI 72.1 to 87.67), COPD (SMR=1.11, 95% CI 0.99 to 1.24) and lung cancer (SMR=1.08; 95% CI 1.00 to 1.18). Coal mine dust exposure increased risk for mortality from pneumoconiosis and COPD. Mortality from COPD was significantly elevated among never [corrected] smokers and former smokers (HR=1.84, 95% CI 1.05 to 3.22; HRK=1.52, 95% CI 0.98 to 2.34, respectively) but not current smokers (HR=0.99, 95% CI 0.76 to 1.28). Respirable silica was positively associated with mortality from pneumoconiosis (HR=1.33, 95% CI 0.94 to 1.33) and COPD (HR=1.04, 95% CI 0.96 to 1.52) in models controlling for coal mine dust. We saw a significant relationship between coal mine dust exposure and lung cancer mortality (HR=1.70; 95% CI 1.02 to 2.83) but not with respirable silica (HR=1.05; 95% CI 0.90 to 1.23). In the most recent follow-up period (2000-2007) both exposures were positively associated with lung cancer mortality, coal mine dust significantly so.

CONCLUSIONS

Our findings support previous studies showing that exposure to coal mine dust and respirable silica leads to increased mortality from malignant and non-malignant respiratory diseases even in the absence of smoking.

The classic pneumoconioses: new epidemiological and laboratory observations

The purpose of this article is to provide an update on selected issues of current interest and recent developments related to 3 types of inorganic mineral dust exposures causing classic forms of pneumoconiosis: coal mine dust, crystalline silica, and asbestos. Common themes include new imaging modalities, emerging exposures, and evolving appreciation of additional adverse health effects associated with exposure to these inorganic mineral dusts.

The influence of dust standards on the prevalence and severity of coal worker's pneumoconiosis at autopsy in the United States of America

CONTEXT

Coal worker's pneumoconiosis is a major occupational lung disease in the United States. The disease is primarily controlled through reducing dust exposure in coal mines using technological improvements and through the establishment of dust standards by regulatory means.

OBJECTIVE

To determine if dust standards established in the US Federal Coal Mine Health and Safety Act of 1969 have reduced the prevalence and severity of coal worker's pneumoconiosis.

DESIGN

The study population included materials from 6103 deceased coal miners submitted to the National Coal Workers' Autopsy Study from 1971 through 1996. Type and severity of coal worker's pneumoconiosis were classified using standardized diagnostic criteria.

RESULTS

Among miners who worked exclusively prior to the 1969 dust standard, 82.6% had coal macules, 46.3% coal nodules, 28.2% silicotic nodules, and 10.3% progressive massive fibrosis. Lower prevalences were noted among miners exposed exclusively to post-1970 dust levels: 58.8% had coal macules, 15.0% coal nodules, 8.0% silicotic nodules, and 1.2% progressive massive fibrosis. The differences in prevalence were highly significant (P < .001) for all types of pneumoconiosis, including progressive massive fibrosis, after adjustment for age, years of mining, and smoking status.

CONCLUSIONS

The study confirms a beneficial impact of the first 25 years of the dust standard established by the 1969 act on the prevalence and severity of coal worker's pneumoconiosis in US coal miners. However, pneumoconiosis continues to occur among miners who have worked entirely within the contemporary standard, suggesting a need for further reductions in exposure to respirable coal mine dust.

Severe occupational pneumoconiosis among West Virginian coal miners: one hundred thirty-eight cases of progressive massive fibrosis compensated between 2000 and 2009

BACKGROUND

Miners inhale dust at work and are at a risk for coal workers pneumoconiosis (CWP), a preventable and potentially fatal lung disease. After regulations were implemented in the 1970s, declines were reported in both dust levels and the prevalence of simple and advanced CWP until about 2001, when despite stable reported dust levels, disease levels sharply increased.

METHODS

A structured, retrospective chart review was performed to describe the demographics and disease progression for 138 coal miners with progressive massive fibrosis (PMF) whose claims were approved by the West Virginia State Occupational Pneumoconiosis Board between January 2000 and December 2009.

RESULTS

PMF, a complication of CWP, developed in 138 West Virginian coal miners at a mean age of 52.6 years after an average of 30 years work tenure. The time of progression averaged 12.2 years from the last normal chest radiograph until PMF was detected. Lung function declined sharply in both smokers and nonsmokers, averaging 87 mL/y for FEV(1) and 74 mL/y for FVC. The board has confirmed 21 deaths in this group. The most common job activities were operating continuous-mining machines (41%) and roof bolting (19%). Virtually all of these miners' dust exposures occurred after the implementation of current federal dust regulations.

CONCLUSIONS

Contemporary occupational dust exposures have resulted over the past decade in rapidly progressive pneumoconiosis and massive fibrosis in relatively young West Virginian coal miners, leading to important lung dysfunction and premature death.

Prevalence characteristics and prediction of coal workers' pneumoconiosis in the Tiefa Colliery in China

To explore characteristics of the development of coal workers' pneumoconiosis (CWP) at present and trend in the future, we investigated 16,154 coal miners exposed to dust for at least 1 yr in the Tiefa Colliery in China. Occupational categories were divided into tunneling, mining, combining and helping. Four cohorts (before 1958, 1958-, 1968-, and after 1978) were created according to years of first exposure. Life-Table Method was used to calculate cumulative incidence rates of CWP adjusted by duration of dust exposure and predict the number of the new CWP patients. Results indicated that cumulative incidence rates of CWP in four cohorts were 26.65%, 18.94%, 1.15%, and 0.06%, respectively (Chi(2)=493.57, p<0.0001). The 55-yr cumulative rate of CWP of tunneling miners (25.90%) or that of combining miners (14.53%) was statistically higher than that of mining miners (7.26%) or that of helping miners (0.89%). The number of new CWP patients predicted in future was approximately 77. New CWP patients predicted would mainly occur among coal miners with first dust exposure in 1958-1967 and those working at tunneling. Most of them could be diagnosed in the age group from 45 to 75 and in the period of the next 20 yr from 2008 to 2028.

Mortality among U.S. underground coal miners: a 23-year follow-up

BACKGROUND

The mortality experience over 22-24 years of 8,899 working coal miners initially medically examined in 1969-1971 at 31 U.S. coal mines was evaluated.

METHODS

A cohort life-table analysis was undertaken on underlying causes of death, and proportional hazards models were fitted to both underlying, and underlying and contributing causes of death.

RESULTS

Elevated mortality from nonviolent causes, nonmalignant respiratory disease (NMRD), and accidents was observed, but lung cancer and stomach cancer mortality were not elevated. Smoking, pneumoconiosis, coal rank region, and cumulative coal mine dust exposure were all predictors of mortality from nonviolent causes and NMRD. Mortality from nonviolent causes and NMRD was related to dust exposure within the complete cohort and also for the never smoker subgroup. Dust exposure relative risks for mortality were similar for pneumoconiosis, NMRD, and chronic airways obstruction.

CONCLUSIONS

The findings confirm and enlarge upon previous results showing that exposure to coal mine dust leads to increased mortality, even in the absence of smoking.

Understanding the chemical properties of macerals and minerals in coal and its potential application for occupational lung disease prevention

Recent increases in oil price further strengthen the argument that coal and coal products will play an increasingly important role in fulfilling the energy needs of our society. Coal is an aggregate of heterogeneous substances composed of organic (macerals) and inorganic (minerals) materials. The objective of this review was to assess whether some chemical parameters in coal play a role in producing environmental health problems. Basic properties of coal--such as chemical forms of the organic materials, structure, compositions of minerals--vary from one coal mine region to another as well as from coals of different ranks. Most importantly, changes in chemical properties of coals due to exposure to air and humidity after mining--a dynamic process--significantly affect toxicity attributed to coal and environmental fate. Although coal is an extremely complex and heterogeneous material, the fundamental properties of coal responsible for environmental and adverse health problems are probably related to the same inducing components of coal. For instance, oxidation of pyrite (FeS2) in the coal forms iron sulfate and sulfuric acid, which produces occupational lung diseases (e.g., pneumoconiosis) and other environmental problems (e.g., acid mine drainage and acid rain). Calcite (CaCO3) contained in certain coals alters the end products of pyrite oxidation, which may make these coals less toxic to human inhalation and less hazardous to environmental pollution. Finally, knowledge gained on understanding of the chemical properties of coals is illustrated to apply for prediction of toxicity due to coal possibly before large-scale mining and prevention of occupational lung disease during mining.

Decline in lung function and mortality: implications for medical monitoring

AIM

To investigate the risk of death associated with selected cut-off points for rate of decline of forced expiratory volume in one second (FEV(1)).

METHODS

Mortality rates of a cohort of 1730 coal miners who had performed two pulmonary function tests 12.8 years apart were followed up for an additional 12 years. Based on previous studies, cut-off points for FEV(1) rate of decline (ml/year) were selected as 30, 60 and 90 ml/year. Cox proportional hazard regression was used to estimate multivariate risk ratio of death in each category.

RESULTS

The risk ratios (compared to "below 30 ml/year") were 1.39 (95% CI 0.99 to 1.97) in the "60 to less than 90 ml/year" category and 1.90 (95% CI 1.32 to 2.76) in the "90 ml/year and above" category. Rates of decline above 90 ml/year were consistently related to excess mortality. In non-smokers and those with neither restrictive nor obstructive patterns at the first survey, rates of decline above 60 ml/year were significantly associated with increased mortality.

CONCLUSIONS

Risk of death increases in individuals with rates of decline above about 60 ml/year and is statistically significant with declines of 90 ml/year or more. These results should be useful to healthcare providers in assessing lung function declines observed in individuals.

24 Years of Pneumoconiosis Mortality Surveillance in Australia

Asbestosis, silicosis and Coal Worker's Pneumoconiosis (CWP) represent three of the most important occupationally-related dust diseases in Australia. To gain a clear picture of pneumoconiosis trends over time, a 24-yr retrospective analysis of national mortality data was performed for the period 1979 to 2002. Over 1,000 pneumoconiosis-related fatalities occurred during this time, 56% of which were caused by asbestosis, 38% by silicosis and 6% by CWP. Between 1979 and 1981, silicosis accounted for 60% of all pneumoconiosis-related fatalities in Australia, followed by asbestosis (31%). By 2002 however, asbestosis was causing 78% of all fatalities, while silicosis accounted for only 19%. Asbestos-related mortality increased three-fold between 1979 and 2002, with a clear excess risk demonstrated among males. On the other hand, mortality rates for silicosis and CWP declined significantly during the same time period. Overall, this study suggests that pneumoconiosis, particularly asbestosis, continues to be an important occupational disease in Australia. Although progress has been made in reducing deaths due to occupational silicosis and CWP, asbestosis rates continue to rise, reflecting the long latency between dust exposure and clinical disease. Countries which continue to use asbestos products in the workplace should note the tragic legacy of this material within contemporary Australia.

Assessment of respirable dust and its free silica contents in different Indian coalmines

Assessment of respirable dust, personal exposures of miners and free silica contents in dust were undertaken to find out the associated risk of coal workers' pneumoconiosis in 9 coal mines of Eastern India during 1988-91. Mine Research Establishment (MRE), 113A Gravimetric Dust Sampler (GDS) and personal samplers (AFC 123), Cassella, London, approved by Director General of Mines Safety (DGMS) were used respectively for monitoring of mine air dust and personal exposures of miners. Fourier Transform Infra-red (FTIR) Spectroscopy determined free silica in respirable dusts. Thermal Conditions like Wet Bulb Globe Temperature (WBGT) index, humidity and wind velocity were also recorded during monitoring. The dust levels in the face return air of both, Board & Pillar (B&P) and Long Wall (LW) mining were found above the permissible level recommended by DGMS, Govt. of India. The drilling, blasting and loading are the major dusty operations in B&P method. Exposures of driller and loader were varied between, 0.81-9.48 mg/m3 and 0.05-9.84 mg/m3 respectively in B&P mining, whereas exposures of DOSCO loader, Shearer operator and Power Support Face Worker were varied between 2.65-9.11 mg/m3, 0.22-10.00 mg/m3 and 0.12-9.32 mg/m3 respectively in LW mining. In open cast mining, compressor and driller operators are the major exposed groups. The percentage silica in respirable dusts found below 5% in all most all the workers except among query loaders and drillers of open cast mines.

Coal-induced interleukin-6 gene expression is mediated through ERKs and p38 MAPK pathways

In the present study, we have tested the ability of coal dust to stimulate kinase phosphorylation of activator protein-1 (AP-1) signal transduction pathways and production of interleukin-6 (IL-6) in both mouse epidermal JB6 and human lung epithelial A549 cells. Seven coal samples from three coalmine regions of Pennsylvania (PA), West Virginia (WV), and Utah (UT) with high, medium, and low prevalence of coal workers' pneumoconiosis (CWP), respectively, were investigated. Results from the present study indicate that three PA coals stimulated the mitogen-activated protein kinase (MAPK) family of extracellular signal-regulated kinases (ERKs) and p38 MAPK, but not c-Jun-NH2-terminal kinases (JNKs) in human lung A549 cells. The effects of three UT coals on the kinase phosphorylation were less as compared to those of the PA coals. Coal dusts from three coalmine regions induced IL-6 in a dose-dependent manner in both JB6 and A549 cells. Interestingly, levels of IL-6 in both cells treated with coals from three coalmine regions correlated well with CWP prevalence from that region. To assess the role of AP-1 pathways in coal-mediated transcriptional activation of IL-6, various inhibitors were used in cells treated with one PA coal, which induced a maximal response. It was found that the increase in IL-6 protein and mRNA by the PA coal was completely eliminated by the pretreatment of both cell types with PD98059, a specific MEK1 inhibitor, and SB202190, a p38 kinase inhibitor. Our results indicate that coal dust can stimulate IL-6 release from mouse epidermal JB6 cells and human lung epithelial A549 cells, and the coal-induced IL-6 increase may involve ERKs and p38 MAPK pathways.

Gene expression of primary human bronchial epithelial cells in response to coal dusts with different prevalence of coal workers' pneumoconiosis

Striking regional differences in the prevalence of coal workers' pneumoconiosis (CWP) have been observed but not fully understood. This study investigated the early biological responses of primary lung cells to treatment with coal dusts from various seams. High-density oligoarray technology (GeneChip, Affymetrix, Santa Clara, CA) was used to compile gene expression profiles of primary human bronchial epithelial cells to low concentrations (2 microg/cm(2)) of coals for 6 h or 24 h of treatment. Data showed that a total of 1050 out of 12,000 genes on the chip were altered by 2 coal dusts. The coal from the Pennsylvania (PA) coal-mine region with a high prevalence of CWP altered 908 genes, many more than the coal from Utah (UT) with a low prevalence of CWP, which affected 356 genes. Many genes decreased their expression levels in response to the PA coal at 6 h and/or 24 h of treatment. For example, transferrin receptor, a gene known to control cellular iron uptake, was downregulated in the cells treated with the iron-containing PA coal in order to protect cells from iron overload. The UT coal without bioavailable iron had no such effect. The downregulation patterns of genes were confirmed by reverse-transcription polymerase chain reaction (RT-PCR). This study is one of the first in profiling gene expressions of primary bronchial epithelial cells treated with coals from various seams, which may set stages for future studies on specific genes.

Induction of interleukin-6 by coal containing bioavailable iron is through both hydroxyl radical and ferryl species

Coal mining causes health problems, such as pneumoconiosis. We have previously shown that prevalence of pneumoconiosis in workers from various coalmine regions positively correlates with levels of bioavailable iron (BAI) in the coals from that region. In the present study, the nature of reactive oxygen species formed by BAI in the coals and its mechanisms of the induction of biological responses were investigated. Human lung epithelial cell line, A549 cells, were used to examine the induction of interleukin-6 (IL-6), a pro-inflammatory cytokine, which is known to play a crucial role in the development of pneumoconiosis. We found that levels of IL-6 protein as well as its mRNA were significantly increased in the cells treated for 24 h with 20 microg/cm2 of the BAI-containing Pennsylvania (PA) coal; for example we observed 6.7-fold increase in IL-6 protein. Levels of IL-6 protein in cells treated with the Utah (UT) coal containing low-BAI were only 1.9-fold of the control levels. The enhancing effect on the IL-6 by the PA coal was similar to that caused by hydrogen peroxide. Superoxide dismutase (SOD), catalase (CAT), and N-acetyl-L-cysteine (NAC) all had inhibitory effects on the PA coal-induced IL-6 formation. However, CAT had the least protective effect as compared to SOD and NAC. Our results indicate that BAI in the PA coal may induce IL-6 through both ferryl species (via iron autoxidation) and hydroxyl radicals (via the Fenton/Haber Weiss reactions).

Role of bioavailable iron in coal dust-induced activation of activator protein-1 and nuclear factor of activated T cells: difference between Pennsylvania and Utah coal dusts

Activator protein-1 (AP-1) and nuclear factor of activated T cells (NFAT) are two important transcription factors responsible for the regulation of cytokines, which are involved in cell proliferation and inflammation. Coal workers' pneumoconiosis (CWP) is an occupational lung disease that may be related to chronic inflammation caused by coal dust exposure. In the present study, we demonstrate that coal from the Pennsylvania (PA) coalmine region, which has a high prevalence of CWP, can activate both AP-1 and NFAT in JB6 mouse epidermal cells. In contrast, coal from the Utah (UT) coalmine region, which has a low prevalence of CWP, has no such effects. The PA coal stimulates mitogen-activated protein kinase (MAPK) family members of extracellular signal-regulated kinases (ERKs) and p38 MAPK but not c-Jun-NH(2)-terminal kinases, as determined by the phosphorylation assay. The increase in AP-1 by the PA coal was completely eliminated by the pretreatment of cells with PD98059, a specific MAPK kinase inhibitor, and SB202190, a p38 kinase inhibitor, further confirming that the PA coal-induced AP-1 activation is mediated through ERKs and p38 MAPK pathways. Deferoxamine (DFO), an iron chelator, synergistically enhanced the PA coal-induced AP-1 activity, but inhibited NFAT activity. For comparison, cells were treated with ferrous sulfate and/or DFO. We have found that iron transactivated both AP-1 and NFAT, and DFO further enhanced iron-induced AP-1 activation but inhibited NFAT. These results indicate that activation of AP-1 and NFAT by the PA coal is through bioavailable iron present in the coal. These data are in agreement with our previous findings that the prevalence of CWP correlates well with levels of bioavailable iron in coals from various mining regions.

Induction of ferritin and lipid peroxidation by coal samples with different prevalence of coal workers' pneumoconiosis: role of iron in the coals

BACKGROUND

Differences in levels of bioavailable iron (BAI) in coal may be responsible for the observed regional differences in the prevalence and severity of coal workers' pneumoconiosis (CWP).

METHODS

Twenty-nine coal samples from three coal mine regions were tested in human lung epithelial Type II A549 cells. They were from Utah (UT), West Virginia (WV), and Pennsylvania (PA) with a prevalence of CWP of 4, 10, and 26%, respectively.

RESULTS

Low molecular weight (LMW) chelators bound iron, a fraction of BAI in the cells released from coals, ferritin, and lipid peroxidation were significantly higher in cells treated with various coals than in control cells, with an increasing order of UT < WV < PA, in parallel to the prevalence of CWP in these coal mine regions. Deferoxamine (DFO), a specific iron chelator, was used to distinguish effects of BAI from those of other transition metals. Our results indicate that BAI in the coals of WV and UT is the main metal species in inducing ferritin and lipid peroxidation. In contrast, biological effects of PA coals are not only from BAI, but from other transition metals as well.

CONCLUSIONS

Based on a large number of coal samples from various seams, the findings of this study provide further evidence that metals, particularly iron, play important roles in coal dust-induced cellular damage, ultimately leading to the development of CWP and contributing to the regional differences in the prevalence of the disease.

Double-blind, randomized trial of scheduled use of a novel barrier cream and an oil-containing lotion for protecting the hands of health care workers

CONTEXT

Many health care workers suffer severe hand irritation, with cracking and bleeding, as a consequence of frequent handwashing and glove use. Integumentary breakdown has major implications for nosocomial infection control and promotes the spread of bloodborne viruses. The potential benefits of scheduled use of hand-care agents-lotions or creams-in health care workers has not been established by controlled trial.

OBJECTIVE

To compare the value of an oil-containing lotion with a novel barrier skin cream in health care workers with severe hand irritation.

DESIGN

Prospective, randomized, double-blind trial.

SETTING

University medical center.

PARTICIPANTS

Fifty-four health care workers from multiple departments with severe hand irritation, 74% with one or more full-thickness cracks or other integumentary breaks.

MAIN OUTCOME MEASURES

Objective and subjective parameters for scaling, cracking, weeping, bleeding, and pain were scored by two blinded investigators weekly for 4 weeks, and the hands of subjects were cultured quantitatively at the onset and after 2 weeks and 4 weeks.

RESULTS

Subjects in both groups experienced marked improvement in overall hand condition (each, P <.02), particularly in scaling, cracking, and pain. Persons randomized to use of the oil-containing lotion showed greater improvement (mean score, from 6.5 to 2.7 vs 6.8 to 4. 7, P =.006). In 18 (69%) of 26 persons who used the control lotion, all full-thickness integumentary breaks were healed and pain was totally resolved, compared with 14 (52%) of 27 persons who used the barrier cream (P =.26). Use of the two agents in a scheduled fashion had no effect on the levels or profile of the transient hand flora. However, by the fourth week of use, handwashing frequency was 50% higher in subjects randomized to use the control lotion than it was in subjects randomized to use the barrier cream (17.8 vs 11.7 times per day, P =.04).

CONCLUSION

Use of an oil-containing lotion or a barrier cream on a scheduled basis can substantially protect the hands of vulnerable health care workers against drying and chemical irritation, preventing skin breakdown and promoting more frequent handwashing.

Chemical reactivity of the carbon-centered free radicals and ferrous iron in coals: role of bioavailable Fe2+ in coal workers pneumoconiosis

Striking differences in the prevalence of coal workers' pneumoconiosis (CWP) exist between different coal mine regions. The major factors responsible for the observed regional differences in CWP have not yet been identified. In the present study, chemical reactivity of the carbon-centered free radicals in coals and lung tissues, as well as ferrous iron in the coals, were studied by ESR techniques. The ESR spectra clearly demonstrated the presence of at least two types of carbon-centered free radical species, which might respectively attribute to the macromolecular phase and the molecular phase of coal. Grinding produced free radicals in coals. Exposure of freshly ground coal to air for 28 h induced a slight increase of free radicals for most of the coals, and a slight decrease after 4 months' exposure. The lung tissue samples of coal workers deceased of CWP showed similar ESR spectra as coal samples, and these radicals were highly stable in the lung. After incubation of coals with glutathione, hydrogen peroxide, sodium formate or oxygen, the coal sample from the Gardanne mine which has never induced CWP, and thus is the least hazardous coal, showed the most significant change in the carbon-centered free radical concentration. No significant changes were observed among other coals reported to induce CWP. On the other hand, we found that the coals released different amounts of Fe2+ in an acidic medium. Interestingly, the prevalence of CWP correlates positively with the released Fe2+ content in these coals and with the amount of oxygen radicals produced by the interaction of Fe2+ with O2 in the acidified coal filtrates. Our studies indicate that the carbon-centered free radicals may not be biologically relevant to coal dust-induced pneumoconiosis, whereas the acid soluble Fe2+, which may be dissolved in the phagolysosomes of macrophages, can then lead to Fe2+-induced oxidative stress and eventual CWP development.

Can the evolution to pneumoconiosis be suspected in coal miners? A longitudinal study

To assess whether the evolution to pneumoconiosis may be suspected in coal miners, we conducted a 4-yr longitudinal study of 80 dust-exposed miners with chest X-ray findings classified 0/1 or 1/0 according to the International Labor Organization (ILO) classification (exposed to coal mine dust, suspected of pneumoconiosis [ES group]) and two control groups having normal X-rays. The first of these latter two groups included 80 miners with similar exposure to that of the first group (exposure with normal X-rays [EN]), whereas the second group consisted of markedly less exposed miners (no exposure with normal X-rays [NN]). The protocol comprised a questionnaire on respiratory symptoms and smoking, assessment of cumulative coal-mine-dust exposure, X-rays, computed tomographic (CT) scans, and lung-function tests. The study was conducted in 1990 and 1994 by the same medical team. At the end of the follow-up, 24 members of the ES group had worsened X-ray findings, and 10 of them had X-ray findings classified as 1/1 or greater. In the EN and NN groups, six and one subjects, respectively, had worsened X-ray findings. At the first examination, subjects who developed pneumoconiosis had significantly lower values for FEV1/FVC ratio, maximum midexpiratory flow (MMEF), and maximal forced expiratory flow at 25% of vital capacity (FEF25%), and higher CT-scan micronodule scores. This latter score and FEF25% were significantly associated with the evolution to pneumoconiosis in the ES group, and scanner micronodule score and MMEF were significantly associated with this in all three groups combined. Worsening findings on X-ray and change to pneumoconiosis must be controlled in coal miners. The findings in this study offer the possibility of identifying miners who especially need follow-up and monitoring.

Prevalence of pneumoconiosis and its relationship to dust exposure in a cohort of U.S. bituminous coal miners and ex-miners

Information on radiographic evidence of coal workers' pneumoconiosis (CWP) is presented for a group of 3,194 underground bituminous coal miners and ex-miners examined between 1985 and 1988. Prevalence of CWP was related to estimated cumulative dust exposure, age, and rank of coal. On the basis of these data, miners of medium to low rank coal, who work for 40 years at the current federal dust limit of 2 mg/m3, are predicted to have a 1.4% risk of having progressive massive fibrosis on retirement. Higher prevalences are predicted for less severe categories of CWP. Miners in high rank coal areas appear to be at greater risk than those mining medium and low rank coals. Ex-miners who said that they left mining for health-related reasons had higher levels of abnormality compared to current miners.

Surveillance data on US coal miners' pneumoconiosis, 1970 to 1986

OBJECTIVES

Statistics on prevalence of pneumoconiosis among working underground coal miners from data collected as part of a large national radiographic surveillance program between 1970 and 1986 are presented. The main intent was to examine the time-related trend in prevalence over this period, which coincides with historically low dust levels mandated by federal act.

METHODS

Tenure-specific prevalence rates and summary statistics derived from them for four consecutive time intervals within the 16-year period were calculated and compared.

RESULTS

The results indicate a reduction in pneumoconiosis over the life of the program. This trend is similar to that seen in epidemiologic studies undertaken concurrently.

CONCLUSIONS

Although low participation in the surveillance program and other problems complicate the findings, it appears that reductions in dust exposure mandated by federal act in 1969 have led to lower prevalence of pneumoconiosis among underground coal miners.

British data on coal miners' pneumoconiosis and relevance to US conditions

OBJECTIVES

The current primary federal dust standard for US underground coal miners of 2 mg/m3 respirable dust is based on British epidemiological information on exposure-response derived in 1969. Since then, much new information has become available. This paper reviews and compares the available information as it relates to the US mining situation.

METHODS

Recent exposure-response information on pneumoconiosis and dust exposure derived by British researchers was employed to estimate working-life risks of pneumoconiosis for miners exposed to 2 mg/m3.

RESULTS

It is estimated that close to 9% of underground coal miners who work for 40 years in a 2 mg/m3 environment would develop pneumoconiosis (category 1 or greater). Progressive massive fibrosis would develop in 0.7%.

CONCLUSIONS

There are unresolved questions relating to the validity of extrapolating findings on British mines and miners to the US and also in predicting disease levels at the low end of the dust exposure spectrum. Given the data available, current information suggests miners who are employed for a working life-time at the current federal dust limit of 2 mg/m3 are still at risk of developing pneumoconiosis.