Appalachia's black lung rates highest in nearly 50 years as miners' protections stall

Like many miners with advanced black lung disease, Tim Balthis looks healthy, sitting with his wife Fran Balthis on their porch in Pound, Va. But a scan of his lungs shows so much fibrotic tissue a doctor told Balthis he was surprised he was still alive. Roger May for NPR hide caption

Respiratory therapist Marcy Freeman doesn't need a research study to confirm for her a return to the dark days of coal mining. She finds evidence in a stack of more than 150 funeral programs, all for former patients at her pulmonary rehabilitation clinic in Norton, Virginia.

"Each one of these represents a life that's gone because of black lung," Freeman explained as she flipped through the programs, recognizing names and images.

Science

Thousands of U.S. countertop workers could have damaged lungs, safety expert says

"These are husbands. These are brothers. … These men were just hardworking men, and the only thing they did was go to work and provide for their families. And it cost them everything. … This is the aftermath of black lung."

Respiratory therapist Marcy Freeman has treated hundreds of coal miners with complicated black lung disease at her clinic in Norton, Va., including her husband, a coal miner who worked close to 27 years underground. Justin Hicks/Louisville Public Media/LPM hide caption

This aftermath is more dire than even black lung clinicians and researchers expected, according to new data published Wednesday in the American Journal of Respiratory and Critical Care Medicine .

The data appears in a peer-reviewed research letter from the National Institute for Occupational Safety and Health (NIOSH), a federal research agency.

Public Health Watch, Kentucky Public Radio and NPR obtained a draft of the NIOSH research letter before publication.

NIOSH researchers found that working veteran underground coal miners in central Appalachia are suffering from the incurable and fatal lung disease at the highest rates in nearly 50 years.

Miners working in Kentucky, Virginia and West Virginia who've had at least 25 years underground have the worst rate of coal workers' pneumoconiosis, or black lung disease. One in three — 32.5% — tested positive in X-rays conducted by NIOSH during the last five years.

The last time the rate of disease was that high for miners with the same work history was 1978. In 2018, when NIOSH last reported rates of the disease , the rate was 20.6%.

The new research shows that even miners with as few as 15 years underground have higher rates of black lung — rates not seen in nearly 40 years.

Shots - Health News

New federal safety rules on silica dust aim to protect miners' lungs

"I'm disgusted," said Scott Laney, a NIOSH research epidemiologist who is the lead author of the research letter.

"This is not going to get better because of all the disease that's already in the pipeline. These guys are being treated like disposable widgets, not human beings. … We're watching them die right before our eyes."

More than 1,700 coal miners died from black lung from 2020 through 2023, according to an earlier NIOSH study .

Kentucky Public Radio and its reporting partners provided the federal Mine Safety and Health Administration (MSHA) a summary of the NIOSH findings, but the agency declined to comment or respond to questions before seeing the published report.

"Coal miners are no better off"

The new findings "should stagger and shock anyone who has compassion for … hardworking people," said Celeste Monforton, a former federal mine-safety regulator and a workplace-safety academic and advocate.

"This is the consequence of their work and the consequence of us wanting cheap electricity," Monforton added. "We're back where we were [nearly 50 years ago]. … Coal miners are no better off than they were [then]."

The newly published findings do not include the number of miners tested or diagnosed in the five-year period used to determine the rate of disease. But in response to questions from Public Health Watch and Kentucky Public Radio, NIOSH said it screened 280 working veteran underground miners in central Appalachia in the past five years, with 91 testing positive for black lung. The agency used that sample to estimate a rate for all similar miners in the region, an approach used since 1974.

Coal miner Jess Bishop near the end of his life, with his sons, both coal miners. Bishop died of black lung disease in 1976, just before Congress passed tough new limits on exposure to the coal mine dust that causes the disease. Earl Dotter hide caption

"The overall process" that NIOSH researchers applied here "is valid in my opinion," said Akshay Sood, a clinical and research pulmonologist specializing in occupational lung diseases, including black lung, at the University of New Mexico School of Medicine. Sood reviewed a draft of the NIOSH research letter at the request of NPR, Kentucky Public Radio and Public Health Watch.

The NIOSH study "reinforces prior observations that disease prevalence continues to increase despite modern dust-control regulations," Sood concluded.

The NIOSH researchers also wrote that "multiple external indicators … demonstrate patterns consistent" with their findings, including thousands of new cases of disease diagnosed by black lung clinics in the last decade.

The new estimated rate for the veteran central Appalachian underground miners is more than a fourfold increase since the prevalence of the disease hit a low point: just 7%, in 1999 . That was 22 years after Congress imposed strict limits on exposure to the coal mine dust that causes black lung.

Coal miners on the U.S. Capitol steps in 1975 demanded congressional action to protect workers from the coal mine dust that causes incurable and fatal black lung disease. Earl Dotter hide caption

Since then, the dramatic plunge has reversed , especially in Appalachia, where thousands of miners are suffering from early, advanced and fatal stages of disease, according to data gathered from clinics testing and treating miners. Unlike NIOSH, which focuses on working miners, the clinics tend to see retired and laid-off miners who seek lung exams while trying to obtain state or federal black lung benefits.

The clinics have been inundated with miners in the wake of coal mine closures. More than 15,000 workers across the U.S. lost coal mine jobs in the last decade, according to employment data from the U.S. Bureau of Labor Statistics .

Radiologist Brandon Crum scrutinizes an image of a coal miner's lungs in his clinic in Coal Run Village, Ky. The lungs were riddled with fibrotic tissue, the breath-stealing signature of black lung disease. Justin Hicks/Kentucky Public Radio hide caption

"It's awful," said Brandon Crum, a radiologist in Coal Run Village, Kentucky, who specializes in detecting signs of black lung in X-rays. In 2016, Crum first documented an alarming spike in severe black lung — as well as rapid progression of the disease — among younger and younger coal miners. NIOSH researchers and an NPR investigation confirmed his findings.

The new NIOSH research indicates to Crum that the trend continues.

"It's just another thing that proves what we've been saying for the last 10 years," he said. "And this may be even worse than what we thought it was going to be."

The National Mining Association (NMA), the leading industry trade group, was also provided a summary of the NIOSH findings. NMA noted that the rates of disease reported by NIOSH in miners tested in the last five years — along with the new cases diagnosed at clinics — do not stem from current silica dust exposures in coal mines because it can take years for disease to develop and for disease to be diagnosed.

"This means that the incidences discussed in these studies cover miners whose initial exposure dates back years and, in many cases, decades," Ashley Burke, a spokeswoman for NMA, wrote in an emailed statement. "These incidences do not reflect the conditions, practices, protections or regulations that are in place today."

Still, miner advocates are concerned that high rates of disease will continue because of a major change in coal mining that's causing dangerous dust exposure.

A wall in the New Beginnings clinic shows many of the coal miners who've been treated there. Respiratory therapist Marcy Freeman also has a collection of funeral programs for those who've died. Justin Hicks/Kentucky Public Radio hide caption

Cutting through rocks

In recent decades, the biggest coal seams in Appalachia were mined out. Mining companies turned to the thinner seams that remained, digging through mountains to reach and then mine them. That requires cutting lots of rock, and in Appalachia, that rock typically contains quartz, which is rich in silica. The result is clouds of both coal dust and highly toxic silica dust.

"Excessive inhalation of coal mine dust is the sole cause of [black lung] in coal miners," the new NIOSH research letter says. "Substantial evidence shows that exposure to the respirable crystalline silica component of coal mine dust plays an important role in contemporary disease patterns."

Laney, the NIOSH epidemiologist, said the link between silica dust and black lung disease is strong, based on exposure data and radiographic data, which shows abnormalities "suggestive of silica exposure." And he said researchers have inspected lungs removed in autopsies and after transplantation and "we can see the silica in these lungs."

A working coal mine preparation plant outside Appalachia, Va. Coal mining continues in the region even though nearly 350 underground mines have closed since 2008, putting thousands of miners out of work. Roger May for NPR hide caption

A thin coal seam no more than a foot thick outside an abandoned underground coal mine near Haysi, Virginia. Now that mining companies are going after thin seams like this, miners are exposed to more silica dust when mining machines cut through the rock. Justin Hicks/Kentucky Public Radio hide caption

Silica dust is 20 times more toxic than coal dust alone and contains fine particles that are easily inhaled. Silica particles cause lungs to fight back with fibrotic tissue that builds and builds, severely inhibiting the ability to breathe.

Coal miners who've worked underground in the last 25 years have witnessed the changes that led to more silica dust exposure.

"The thickness of the coal is not there," explained Tim Balthis, a former miner and mine foreman in Kentucky and Virginia. It's not like the days when the "grandpas" mined the big coal seams, he said. "So you're having to take more rock, which in turn creates silica dust."