CDC’s Coal Workers’ Health Surveillance Program

Coal worker’s pneumoconiosis (CWP), commonly known as black lung disease is an occupational lung disease caused by inhaling coal mine dust, which results in scarring of the lungs and emphysema, shortness of breath, disability and premature death. In the last decade, over 10,000 miners have died of CWP.

Starting with the Coal Mine Health and Safety Act of 1969, and its amendment, the Mine Safety and Health Act of 1977, the U.S. government has worked to reduce the prevalence of black lung disease through the implementation of health and safety measures. In particular, the Division of Respiratory Disease Studies (DRDS) in CDC’s National Institute for Occupational Safety and Health (NIOSH) has worked side-by-side with miners to provide them with periodic chest x-rays that are used to detect and assess the severity of black lung.

While the prevalence of black lung disease had decreased by about 90 percent from 1969–1995, the downward trend of this disease in underground coal miners has stopped. In fact, since 1995 the prevalence of black lung cases among those who have mined coal for more than 20 years has more than doubled. Also, younger underground miners, some as early as in their 30s, have been identified as having severe and advanced disease.

Identification of advanced disease 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 standards mandated by the 1969 federal legislation. In a recent publication in MMWR, NIOSH scientists found that an increased risk of CWP was associated with work in certain mining jobs, in smaller mines, in specific geographic areas and among contract miners.

To help recognize early disease in underground coal miners and to enable those with black lung to take action to reduce their dust exposures, NIOSH operates the Coal Workers' Health Surveillance Program. This program allows miners to receive health evaluations (including a chest x-ray) at hire, after three years and subsequently every five years. These evaluations are paid for by the mine operator and are done at a medical facility approved by NIOSH. Health evaluations are important since chest x-rays can detect the early signs of CWP and can detect lung changes often before the miner is aware of any breathing problems.

As an outreach effort, NIOSH, in collaboration with the Mine Safety and Health Administration (MSHA), has implemented the Enhanced Coal Workers’ Health Surveillance Program. This program uses a specially designed mobile examination unit to perform health evaluations, develop worker histories and collect other relevant health information. The mobile unit travels to coal mining regions around the United States that are considered hot spots for disease. The program, while being focused on disease prevention in individual miners, also provides the opportunity to gather information for ongoing surveillance of black lung. The information is used to monitor trends, identify hot spots, guide prevention and identify risk factors for the disease.

To learn more about NIOSH’s efforts to reduce the prevalence of black lung disease, visit the NIOSH Web site. For a personal account of the devastating effect of black lung disease on a miner’s life, view the following short, educational video.