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Coal workers' pneumoconiosis-related years of potential life lost before age 65 years - United States, 1968 - 2006.

Mazurek-JM; Laney-AS; Wood-JM
MMWR 2009 Dec; 58(50):1412-1416
Coal workers' pneumoconiosis (CWP) is a preventable, slowly progressive parenchymal lung disease caused by inhalation and deposition of coal mine dust in the lungs. The incidence and rate of CWP progression is related to the amount of respirable coal dust to which miners were exposed during their working lifetime. Early pneumoconiosis can be asymptomatic, but advanced disease often leads to disability and premature death. To characterize the impact of premature mortality attributed to CWP in the United States, CDC's National Institute for Occupational Safety and Health (NIOSH) analyzed annual underlying cause of death data from 1968--2006, the most recent years for which complete data were available. Years of potential life lost before age 65 years (YPLL), and mean YPLL were calculated using standard methodology. This report describes the results of that analysis, which indicate that during 1968--2006, a total of 22,625 YPLL were attributed to CWP (mean per decedent: 5.7). Annual YPLL attributed to CWP decreased 91.2%, from an average of 1,484 YPLL per year during 1968--1972 to 154 per year during 2002--2006. However, annual YPLL from CWP have been increasing since 2002, from 135 in that year to 169 YPLL in 2006, suggesting a need for strengthening CWP prevention measures. CDC intends to maintain surveillance of CWP deaths to determine future trends and promote safer work environments. NIOSH maintains a mortality surveillance system for work-related respiratory diseases. Data are drawn from CDC's National Center for Health Statistics (NCHS) multiple cause-of-death data files, which include all deaths in the United States since 1968. YPLL and mean YPLL were calculated using mortality data for 5-year age groups. For this analysis, decedents for whom the International Classification of Diseases (ICD) code for CWP was listed as the underlying cause of death were identified from 1968--2006 mortality data. Deaths with the ICD-10 underlying cause of death coded as J65 (pneumoconiosis associated with tuberculosis) were included if code J60 (coal workers' pneumoconiosis) also was recorded on the death certificate. Because CWP results solely from >10 years of occupational exposure, only deaths of persons aged >/=25 years were considered. A simple linear regression model was used for time-trend analysis of YPLL (using 5-year moving averages). During 1968--2006, CWP was identified as the underlying cause of death for 28,912 decedents aged >/=25 years. Of these, 3,983 (13.8%) were aged 25--64 years, including four (0.1%) aged 25--34 years, 40 (1.0%) aged 35--44 years, 494 (12.4%) aged 45--54 years, and 3,445 (86.5%) aged 55--64 years, accounting for 22,625 YPLL (mean per decedent: 5.7). Among CWP decedents aged 25--64 years, 3,954 (99.3%) were male and 3,891 (97.7%) were white, accounting for 22,283 (98.5%) and 21,893 (96.8%) YPLL, respectively. The mean YPLL per decedent was greatest for the few females (11.8) and blacks (8.1). Overall, CWP deaths among U.S. residents aged >/=25 years declined 73%, from an average of 1,106.2 per year during 1968--1972 to 300.0 per year during 2002--2006 (regression trend, p<0.001). Age-adjusted death rates among residents aged 25--64 years declined 96%, from 1.78 per million in 1968 to 0.07 in 2006; age-adjusted death rates among residents aged >/=65 years declined 84%, from 6.24 per million in 1968 to 1.02 in 2006. CWP-attributable YPLL varied annually, from a high of 1,768 (mean per decedent: 6.0) in 1970 to a low of 66 (mean per decedent: 5.5) in 2001. YPLL increased from 66 in 2001 to 198 in 2005, and then declined to 169 in 2006. Overall, YPLL decreased 91%, from an average of 1,484.2 per year during 1968--1972 to 153.8 per year during 2002--2006 (regression trend, p<0.001). The mean YPLL per decedent increased 47%, from 5.3 per decedent during 1968--1972 to 7.8 during 2002--2006 (regression trend, p<0.001). During 1968--2006, CWP deaths in Pennsylvania (2,845; 15,420 YPLL), West Virginia (281; 1,640 YPLL), Virginia (191; 1,314 YPLL), Kentucky (209; 1,273 YPLL), and Ohio (91; 543 YPLL) accounted for 90.8% of all decedents aged 25--64 years with CWP as the underlying cause of death and 89.2% of the total YPLL attributed to CWP.
Respiratory-system-disorders; Pulmonary-system-disorders; Coal-workers-pneumoconiosis; Mortality-data; Mortality-rates; Mortality-surveys; Surveillance-programs; Statistical-analysis
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Journal Article
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NIOSH Division
Source Name
Morbidity and Mortality Weekly Report