Progressive Massive Fibrosis Resurgence Identified in U.S. Coal Miners Filing for Black Lung Benefits, 1970-2016

Abstract

Rationale: There has been a resurgence of progressive massive fibrosis (PMF) in the United States, particularly among central Appalachian miners.

Objectives: We characterized the proportion of PMF among former U.S. coal miners applying for Federal Black Lung Program benefits, 1970-2016.

Methods: Data from the U.S. Department of Labor were used to characterize trends in proportion of PMF cases, defined as an approved black lung claim with a determination of PMF, among all miners who filed for federal benefits between January 1, 1970, and December 31, 2016. Joinpoint, logistic, and linear regression models were used to identify changes in the proportion of claimants with PMF over time.

Results: There were 4,679 unique PMF cases among claimants for federal black lung benefits between 1970 and 2016, with 2,474 miners determined to have PMF since 1996. The number of PMF cases among Federal Black Lung Program claimants fell from 404 (0.5% of claimants) in 1978 to a low of 18 cases (0.6%) in 1988, and then increased to 353 cases (8.3%) in 2014. The proportion of federal black lung benefits claimants with PMF has been increasing since 1978 (0.06% annual percent change [APC]; 95% confidence interval [CI], 0.05-0.07%; P < 0.0001), and began increasing at a significantly increased rate after 1996 (0.26% APC; 95% CI, 0.25-0.28%; P < 0.0001). Most miners with PMF (84%) last mined in West Virginia, Kentucky, Pennsylvania, or Virginia. Since 1970, the proportion of claimants with PMF has increased significantly among miners who last worked in Kentucky (16.6% APC; 95% CI, 16.5-16.7%), Pennsylvania (4.7% APC; 95% CI, 4.6-4.8%), Tennessee (16.1% APC; 95% CI, 15.7-16.4%), West Virginia (16.8% APC; 95% CI, 16.6-16.9%), and most sharply among miners last working in Virginia (31.5% APC; 95% CI, 31.2-31.7%), where in 2009, more than 17% of claimants received a PMF determination. The proportion of PMF determinations for the rest of the United States has not exceeded 4%.

Conclusions: There has been a resurgence of PMF, particularly in central Appalachian miners. The resurgence of this preventable disease points to the need for improved primary and secondary prevention of dust-related lung disease in U.S. coal miners.

Keywords: black lung benefits; coal mine dust; coal workers’ pneumoconiosis; progressive massive fibrosis.

Figure 1.

Number of miners filing for Federal Black Lung Program benefits and found to have a determination of progressive massive fibrosis (PMF) compared with average annual coal mine employment, 1970–2016. The number of claimants with PMF from 1970 to 1972 is combined because of small numbers. Office workers are included in employment totals from 1973 to 1977. Data sources: U.S. Department of Labor, Office of Workers’ Compensation Programs, Division of Coal Mine Workers’ Compensation; U.S. Department of Labor, Mine Safety and Health Administration; and the U.S. Energy Information Administration.

Figure 2.

Number of claimants for Federal Black Lung Program benefits and the percentage of these claimants that received a determination of progressive massive fibrosis (PMF) during their claim process, 1970–2016. Observed and Joinpoint regression model results are displayed. Data restricted to those miners with between 5 and 60 years of coal mine employment. Data source: U.S. Department of Labor, Office of Workers’ Compensation Programs, Division of Coal Mine Workers’ Compensation.

Figure 3.

Percentage of claimants for Federal Black Lung Program benefits who received a determination of progressive massive fibrosis (PMF) during their claim process in the central Appalachian states of Kentucky, Virginia, and West Virginia compared with the rest of the United States, 1970–2016. Data restricted to those miners with between 5 and 60 years of coal mine employment. Data source: U.S. Department of Labor, Office of Workers’ Compensation Programs, Division of Coal Mine Workers’ Compensation.

Figure 4.

Average annual percent change in the proportion of coal miners with PMF among Federal Black Lung Program claimants by state, 1970–2016. Hawaii and Alaska had no cases of PMF and are not pictured. Data restricted to those miners with between 5 and 60 years of coal mine employment. Data source: U.S. Department of Labor, Office of Workers’ Compensation Programs, Division of Coal Mine Workers’ Compensation.