Researchers from the University of Illinois at Chicago School of Public Health have found the number of cases of progressive massive fibrosis (PMF), the most severe form of black lung disease, is increasing dramatically in the central Appalachia Mountains in the eastern US.

PMF is caused by inhaling dust and other particulates which can damage the lungs. The number of cases of black lung had been declining dramatically since the Federal Coal Mine Health and Safety Act of 1969, which was amended in 1977 and set dust limits on US coal mines. Just 31 cases were reported between 1990 and 1999 as part of the Coal Workers’ Health Surveillance Program, but this figure has since increased to 49 in 2016 alone.

Research assistant professor of environmental and occupational health sciences at the university Kirsten Almberg said: “The miners affected appear to be working in smaller mines that may have less investment in dust reduction systems. Due to changes in mining practices over time, mines today may produce higher levels of crystalline silica, which is more damaging to the lungs than coal dust, during coal extraction.

“And minors appear to be working longer hours and more days per week, leaving less time for their lungs to clear the dust that has been inhaled.”

Almberg’s team found that of the 4,679 cases of PMF reported between 1970 and 2016, over half were reported after 1996. They also found a related increase in the number of miners applying for black lung benefits, and that the trend is most prevalent in Virginia, West Virginia and Kentucky.

According to the team, many miners do not file claims or participate in medical examinations while they are working, out of fear that they may have the disease. Those who do seek medical attention have often already left work, at which point their condition is advanced and more difficult to treat, and the person has to navigate what the University of Illinois at Chicago calls an ‘adversarial claims process’ which may not result in compensation for many years.

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“More research is needed to determine the causes of this increase in disease, but what is clear is that miners in recent decades have been over-exposed to dust, and ways to reduce these exposures is much-needed,” said Almberg.