Coal workers' pneumoconiosis in U.S. coal mines: a review of exposures, interventions, and outcomes

Despite nearly forty-five years of protective dust rules, U.S. coal miners still experience an alarming level of coal workers’ pneumoconiosis, a debilitating and deadly lung disease. For miners that have worked entirely under these dust rules, the probability of developing the second level of disease or greater should be zero for a 35 year career. Recent surveillance has pegged the number at over two percent, with eight percent of experienced miners exhibiting some evidence of the disease. Nearly 1,000 miners and former miners succumb to the disease annually, establishing it as a serious public health issue, and making it the deadliest mining-related hazard in the U.S., far ahead of widely publicized roof falls, fires, and explosions. \ud The National Institute for Occupational Safety and Health and other research organizations have suggested a series of possible causes for the continued prevalence of coal workers’ pneumoconiosis, including extended shift lengths, increased mining of higher quartz-bearing coal and rock seams, and insufficient dust rule enforcement. This paper presents many of the broader risks for developing coal workers’ pneumoconiosis as well as a discussion of the impact of specific exposure characteristics. \ud In the coal dust regulations developed in 1969, a seemingly comprehensive approach to control exposures was employed: regulation and enforcement, dust control research, medical surveillance, and worker compensation. While the present system addresses several of the risk factors leading to coal workers’ pneumoconiosis, it fails to account for the disparity between current documented dust exposures and expected rates of the disease, especially in localized regions. This paper briefly discusses the activities of each component, noting the successes and shortcomings experienced. The current approach to worker exposure control is reviewed along with the prospects of reducing the prevalence of this deadly and debilitating disease. Recommendations are presented to suggest improved approaches to control exposure to coal mine dust and prevent the resulting diseases