1. Black Lung February, 2009 WV Coal Association Charleston, WV TMTM The findings and conclusions in this poster have not been formally disseminated by NIOSH and should not be construed to represent any agency determination or policy.

2. 50 th wedding anniversary, 1971 My Maternal Grandfather Died age 96 Coal miner in the Somerset coalfield, England

3. Black Lung Collection of diseases –Pneumoconiosis –Chronic obstructive pulmonary disease –Emphysema

4. Pneumoconiosis –Fibrotic diseases of the lungs caused by inhalation of dusts –Coal workers’ pneumoconiosis (CWP), from coal mine dust –Severe form is Progressive Massive Fibrosis (PMF) –Silicosis, from silica dust –Both can lead to disability and premature mortality –Very difficult to distinguish between them on the x-ray

5. PMF ‘Simple’ CWP Progressive massive fibrosis Complicated pneumoconiosis Normal

6. Pneumoconiosis is not caused by smoking! …

7. Disease Prevention Primary disease prevention –Dust control –Alternatives –Ventilation –Respirators Secondary disease prevention –Early detection of disease and reduction/elimination of further exposure

8. NIOSH coal miner programs NIOSH runs two related programs for worker monitoring for pneumoconiosis –Regular program – mine-based using clinics to obtain x-rays –Enhanced program – community-based using NIOSH mobile van

9. NIOSH coal miner programs Both programs have two major uses – –Secondary disease prevention through entitlement to a low dust working environment if pneumoconiosis is seen –Population surveillance data to monitor effectiveness of dust control, identify problems, and assess trends.

10. Secondary prevention May slow down or prevent severe disease development My grandfather left coal mining when pneumoconiosis was found However, those with simple pneumoconiosis are at greatly increased risk of severe disease, regardless of future dust exposure Secondary prevention reduces the likelihood of future severe disease but does not prevent its development Only adequate dust control prevents disease

11. National surveillance findings

12. CWP hot spot areas

13. CWP Hot Spot Areas

14. Percent of miners with CWP by tenure in mining, 1970-1999

15. Percent of miners with CWP by tenure in mining, 1970-2006

16. Number of miners with any CWP by age, 2000-2009

17. Number of miners with severe CWP by age, 2000-2009

18. Deaths with CWP, age 15-44, national data Rising?

19. A recent death with severe CWP Died age 66 27 years as a coal miner 17 years underground

20. West Virginia

21. Mortality with CWP

22. CWP Mortality rates – highest counties in the nation

23. WV in 2008 – pneumoconiosis observed 1,517 coal miners examined in NIOSH program –Mean age = 47 years –Mean mining tenure = 22 years –91 with any pneumoconiosis –23 with PMF

24. WV in 2008 – expected ~6 times ~15 times

25. Reasons for increase Longer hours worked? Greater production? Inadequate compliance for coal mine dust? Increased exposure to silica dust? Inadequate compliance method for silica? (Dust limits are too high)

26. Reasons for increase Longer hours worked? Greater production? Inadequate compliance for coal mine dust? Increased exposure to silica dust? Inadequate compliance method for silica? (Dust limits are too high)

27. Hours worked/year Data from MSHA website

28. Reasons for increase Longer hours worked? Greater production? Inadequate compliance for coal mine dust? Increased exposure to silica dust? Inadequate compliance method for silica? (Dust limits are too high)

29. West Virginia coal employment and productivity Miners Productivity

30. Reasons for increase Longer hours worked? Greater production? Inadequate compliance for coal mine dust ? Increased exposure to silica dust? Inadequate compliance method for silica? (Dust limits are too high)

31. WV coal mine dust levels

32. “Using two statistical approaches, data from three mining occupations in 54 large underground coal mines during 1976-1978 are examined for evidence of underreporting…Both approaches suggest widespread underreporting.”

34. MSHA Special Inspection survey, 1991

35. Reasons for increase Longer hours worked? Greater production? Inadequate compliance for coal mine dust? Increased exposure to silica dust Inadequate compliance method for silica? (Dust limit are too high)

36. WV in 2008 – expected ~6 times ~15 times

37. WV in 2008 – pneumoconiosis expected (3)

38. Implication Another factor apart from excessive coal mine dust exposure at work Preliminary findings from our program support the interpretation that the increase is partly due to an increase in silicosis

39. Historical evidence

40. Reasons for increase Longer hours worked? Greater production? Inadequate compliance for coal mine dust? Increased exposure to silica dust? Inadequate compliance method for silica? (Dust limits are too high)

41. WV silica dust levels

43. “Although all of the analytical methods for crystalline free silica area sufficiently sensitive to be able to detect and quantitate free silica at environmentally significant concentrations, they are all plagued with similar difficulties.”

44. Summary – What we know Prevalence of pneumoconiosis in miners with 20+ years of tenure x-rayed in the NIOSH monitoring program is rising Cases of severe disease continue to be seen in younger workers (<40 years old) Prevalence of pneumoconiosis far greater than expected from reported dust levels

45. Summary – What we are unsure about Exact cause of increase in prevalence and severity is not known Multiple causes may be at work –Longer hours worked –Inadequate compliance coupled with increased productivity –Thin seam mining due to depletion of best coal reserves, leading to excess silica exposure and silicosis –Lack of knowledge/resources in small mines

46. Primary Solutions Modify compliance method for coal dust including use of personal dust monitor (being tested by NIOSH) More state assistance in county extension work for smaller mines? Adopt NIOSH recommended exposure limits for coal mine dust and silica levels Change compliance assessment method for silica dust (NIOSH recommendation)

47. Take Home Message Black Lung is entirely preventable using dust control No other prevention method (respirators, x-rays) can guarantee such success It behooves every employer and employee to minimize dust production Especial care is needed when rock is being cut

48. MSHA Special Inspection survey, 1991

49. Effect of coal rank

51. Dust levels pre-1969 and in the early 1970s

52. WV silica levels in coal mines NIOSH REL = 0.05 mg/m 3

53. Dust levels in WV mines