Coal and Mineral Mass Fractions in Personal Respirable Dust Samples Collected by Central Appalachian Miners

"After nearly four decades of decline, the prevalence of coal workers’ pneumoconiosis (CWP, or black lung) in the United States has been on the rise since the mid-1990s (Laney et al., 2014; Laney et al., 2010; Suarthana et al., 2011; Pollock et al., 2010; Antao et al., 2005; Blackley et al., 2016). Particularly alarming is the number of cases of rapidly progressive disease such as progressive massive fibrosis (PMF) (Pollock et al., 2010; Antao et al., 2005; Blackley et al., 2016; Laney et al., 2017). A recent study by Laney et al. (2017) observed 192 U.S. coal miners participating in the Coal Workers’ Health Surveillance Program (CWHSP) who had been diagnosed with PMF since 2000. Of the 163 (85 percent) that had a normal radiograph on file to use as a baseline, 27 (17 percent) of these individuals had progressed from a normal radiograph to PMF diagnosis in less than 10 years. Moreover, 162 (84 percent) of the individuals in that study worked in Kentucky, West Virginia or Virginia, and 169 (88 percent) had only ever mined underground. Blackley et al. (2016) also reported on a group of 60 PMF cases that were discovered by a single black lung clinic in eastern Kentucky. Since seeking care at such clinics and participation in the CWHSP are voluntary, and could be influenced by a number of factors, there has been some concern that these reports may overestimate the degree of resurgence in severe disease (i.e., versus disease that was previously under-reported). Even so, they highlight a critical need to better understand the cause(s) of disease development and progression — such that effective interventions can be devised.The notable uptick in CWP and PMF rates among miners in central Appalachia has led to this region being called a hot spot for disease (Pollock et al., 2010; Antao et al., 2005; Blackley et al., 2014; Laney et al., 2017). While the geographic clustering has been well documented (Pollock et al., 2010; Antao et al., 2005; Wade et al., 2011; Wang et al., 2013), the root cause is still unknown. Leading hypotheses have focused on the relative amount of rock being cut along with coal in many central Appalachian mines, as there has been a tendency to mine increasingly thinner coal seams over the past couple of decades (Laney et al., 2010; Schatzel, 2009). This shift has likely been accompanied by changes in specific dust exposure factors, such as increased abundance of particularly harmful dust constituents (e.g., silica or silicates) or increased frequency of harmful exposures (e.g., due to work in more risky environments) (Pollock et al., 2010; Blackley et al., 2016; Cohen et al., 2016; Douglas et al., 1986)."