NIOSH Data Confirms That Black Lung Disease Has Grown in Recent Years Due to Silica Dust

     Mining coal kills. It does so slowly, through black lung disease, or Pneumoconiosis. Data for the National Institute for Occupational Safety and Health (NIOSH), accepted for publication in the American Journal of Respiratory and Critical Care Medicine, indicates that Black Lung is on the rise again.

“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.”

     Coal miners in Central Appalachia, in the states of Kentucky, Virginia, and West Virginia, have been most affected by the disease’s reprisal. About one third of the miners in those states with 25 years of mining experience have the disease. More miners with 15 years of mining experience are getting the disease.

     According to NPR, which has covered black lung disease for a long time, including with in-depth reporting from relevant state affiliates:

"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.”

“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]."

     Apparently, modern dust control methods and regulations have not slowed the disease as hoped.

“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 30 years after Congress imposed strict limits on exposure to the coal mine dust that causes black lung.”

“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.”

     NIOSH emphasizes that silica dust is a factor in these new disease cases as well. The practice of “cutting rock,” or cutting through sandstone and siltstone with high silica content with mining machines in order to reach thinner coal seams, is very likely increasing disease rates.

 "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."

     However, the National Mining Association (NMA) noted:

“…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."

     While silica dust has long been a part of coal mine dust, its level relative to coal dust has been increasing as more rock is cut through to reach thinner coal seams.

“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.”

     While it is good news that compliance rates for mine dust have grown, reaching 97% compliance recently, that may not be enough.

     In 2024, the Biden administration adopted new rules for silica dust in coal mines, cutting the exposure limit by half. The mining industry sued. They were ok with the limits but not the enforcement mechanisms, such as fines and higher dust restrictions for those out of compliance. The lawsuits put enforcement on hold, and the Trump administration endorsed keeping it on hold.

     Dust masks and respirators are an important way to mitigate exposure, but there are issues with them.

“Dust masks and respirators have also been problematic. Many miners interviewed by NPR complained that masks impair communication in a dangerous and noisy environment, become clogged with dust, are too hot to work in, and fail to screen out finer particles. Lawsuits against dust-mask companies have resulted in multimillion-dollar verdicts and settlements.”

     According to the NIOSH report:

“Excessive inhalation of coal mine dust is the sole cause of CWP in coal miners. Substantial evidence indicates that exposure to the respirable crystalline silica component of coal mine dust plays an important role in contemporary disease patterns, particularly in central Appalachia. These observations contributed to 2024 rulemaking by the Mine Safety and Health Administration (MSHA) to reduce occupational exposure to respirable crystalline silica. A recent MSHA Program Information Bulletin notes that in accordance with a federal court order issued April 11, 2025, MSHA has delayed enforcement of the 2024 Silica Rule and instead is enforcing standards that were in place before its changes were to take effect. Pending the outcome of litigation, it is uncertain whether or when the 2024 Silica Rule will be implemented. What is certain is that the prevalence of pneumoconiosis among coal workers participating in CWHSP has reached its highest level in the past 35 years.”

     Below, the article addresses funding for black lung treatment.

“The growing rate of disease has resulted in a steady stream of miners seeking state and federal benefits for living and medical expenses. More than 26,000 miners or their surviving dependents drew $175 million from a federal black lung trust fund in 2024, according to a Labor Department report to Congress.”

“Mining companies contributed more than $23 billion to the fund, according to NMA, but bankruptcies and underinsurance shift some of the burden to taxpayers. The fund owes more than $6.5 billion to the U.S. Treasury.”

“Public funds pay for most of a growing number of lung transplants, which cost as much as $2 million each, and are mostly for miners in central Appalachia, according to a NIOSH study.”

 

 

References:

 

Black lung rates in Appalachia are high as the 1970s, with thousands of miners sick. Howard Berkes and Justin Hicks. Morning Edition. NPR. August 5, 2026. Appalachia's black lung rates are highest in nearly 50 years : NPR

Coal Workers' Pneumoconiosis in the United States 1974—2025: Prevalence in Central Appalachia Continues to Increase. A Scott Laney, PhD , Nirmala T Myers, PhD , Laura E Reynolds, RN , David J Blackley, DrPH , and Noemi B Hall, PhD. American Journal of Respiratory and Critical Care Medicine. August 4, 2026. Coal Workers' Pneumoconiosis in the United States 1974—2025: Prevalence in Central Appalachia Continues to Increase | American Journal of Respiratory and Critical Care Medicine | Oxford Academic