by Laura Ungar
Long linked to underground coal mining, black-lung disease also strikes miners who work above ground — hitting hardest in the Kentucky region.
Those are the findings of a new report by the U.S. Centers for Disease Control and Prevention, the first assessment in a decade of black-lung disease in surface miners.
It found that 46 of 2,257 surface miners tested during 2010-11 had black lung, meaning roughly 2 percent had the potentially deadly respiratory condition caused by inhaling coal dust. Twelve had the most severe form, and the majority never worked underground.
“The numbers are higher than what you’d expect. We would expect it to be essentially zero,” said CDC researcher Cara Halldin, an epidemic intelligence service officer. “This is a workforce that has previously been thought to not have the disease or not have much disease.”
And black lung was much more prevalent among surface miners in Kentucky, Virginia and West Virginia than those in other coal-mining states studied — with 31 of the 46 cases from the three Central Appalachian states.
That works out to 3.7 percent of the Central Appalachian miners, compared with 2 percent of all surface miners and about 3.2 percent of underground coal miners nationally.
Although the study didn’t measure Kentucky separately, Halldin said that 13 of 230 Kentucky surface miners tested — or 5.7 percent — had black lung, which she said gives the state “a disproportionate burden.
Halldin said she’s not sure why Central Appalachia’s rates are so high, but she surmised that it could be linked to more years spent mining, area geology or the safety culture at mines.
“Working in surface-mining conditions exposes a miner to dust. There’s drilling, blasting, dumping of rock, dumping of coal,” said Stephen Sanders, director of the Appalachian Citizens’ Law Center in Whitesburg, Ky. “People have had the idea that you’re working outdoors in open air, you’re not exposed to dust. But you are.”
John Bud Ritchie, 76, of Talcum, Ky., a retired surface miner with black lung, said he recalls working in dusty conditions as a foreman at a surface mine in Eastern Kentucky’s Knott County.
“Coal mining is really, really dusty. Don’t matter what you do, you’re in the dust,” said Ritchie, who retired in 1995. “It’s real rough. You can’t hardly keep the dust down on hot days.”
Bill Bissett, president of the Kentucky Coal Association, an industry group, said about half the mines in Eastern Kentucky are surface mines, compared with about 15 percent in Western Kentucky. Bissett said he plans to share the CDC study with his membership and examine it more closely.
“It is concerning, because if someone has a case of black lung, we want to know this and do everything we can to prevent the disease,” he said. “Why we’re seeing (black lung) more in Appalachian states is a good question.”
Short of breath
Black lung, or coal workers’ pneumoconiosis, occurs when a miner inhales dust over many years, triggering inflammation of the alveoli, the primary gas exchange units of the lungs. The disease can be simple or advanced, with the most serious form called progressive massive fibrosis.
“Some patients have the more mild form, while others develop the progressive disease … which ends up destroying the entire lung,” said Dr. David Mannino, a University of Kentucky pulmonologist. “We’ve had patients who have required lung transplants.”
Ritchie said he was diagnosed in 2008, and doctors removed part of his left lung. Now, he struggles just to get around.
“You walk and you run out of breath,” he said. “You ain’t got much breath to do much.”
CDC researchers said surface miners constitute 48 percent of the coal mining workforce nationally, but black lung in this population hadn’t been studied since 2002.
So the CDC examined the chest X-rays of 2,328 miners screened during the Coal Workers’ Health Surveillance Program of the National Institute for Occupational Safety and Health, a part of CDC. A total of 2,257 miners had a year or more of surface mining experience.
A mobile surveillance unit traveled to Kentucky and 15 other states with active surface coal mines to offer chest X-rays to miners, with site selection based partly on the cooperation of mine operators, who aren’t required to offer the X-rays.
Researchers collected the work histories of miners, and found that those from Central Appalachia spent more years in mines — typically working 28 years, compared with 20 years among non-Appalachian miners studied.
In addition to finding black lung, a high proportion of the X-rays also suggested silicosis, a disease caused by inhaling crystalline silica.
The study points out that a 1969 law established a federal exposure limit for “respirable dust” in underground and surface coal mines — 2 milligrams of coal dust per cubic meter of air — as well as a surveillance system for assessing prevalence of black lung among underground coal miners.
But the requirement for surveillance doesn’t extend to surface miners.
“Industry should recognize this is a problem and their workers are at risk and bring down the levels,” the CDC’s Halldin said.
In an editorial note in the study, researchers suggested the dust limits themselves might need to come down, writing, “federal permissible dust exposure limits might be insufficient to protect against disease or are not being adequately controlled to prevent dust exposure.”
Bissett, of the coal industry group, said surface mine operators face some of the same challenges as others involved in earth-moving activities such as agriculture or road construction — and all take measures to reduce dust.
Bissett said one measure is using climate-controlled mining equipment, but he doesn’t know all the details of how operators control dust at surface mines.
Sanders said they often wet roads with water or use vacuums on equipment, and NIOSH officials pointed to modifications in drilling equipment to capture dust generated by drills, and enclosed operator cabs with air filtration systems on surface mining equipment.
But Tony Oppegard, a Lexington safety advocate and lawyer who represents miners, said the prevalence of black lung “speaks to the lack of concern on the part of industry to control dust and meet safety standards.”
He said one factor in Kentucky may be the lack of unions in the mines.
“Non-union miners are job-scared” and may be wary of complaining about dusty conditions or safety issues, he said. “It’s a product of non-union workplaces. It’s sad, really.”
Bissett disagreed with Oppegard’s assessment. He said, “Tony remains very loyal to the days of the (United Mine Workers of America),” but less than 3 percent of Kentucky mines are unionized today, and workers have good wages and great benefits.
He said companies care about their workers’ safety and health, participating in black-lung screening programs while also working to prevent the disease in the first place.
Sanders said he hopes the federal government adopts more stringent limits on coal dust. The federal Mine Safety and Health Administration is proposing to cut in half the 2 milligram dust limit.
“I would hope this (CDC) study pushes this process along,” Sanders said. “It’s just so important.”
Oppegard said he ultimately hopes that miners — above and below ground — no longer have to work in unhealthy and dangerous conditions.
“A lot of people don’t understand the safety and health risks of strip mines,” Oppegard said. “No one should have to risk their health or safety in order to provide for their family.”