Black Lung Disease Rates Surge Among Appalachian Miners

Federal surveillance data released by the National Institute for Occupational Safety and Health (NIOSH) show that 32.5% of veteran underground coal miners with at least 25 years of service in central Appalachia – Kentucky, Virginia and West Virginia – tested positive for coal workers' pneumoconiosis, the highest rate recorded since 1978. The rate had fallen to a low of about 7% in 1999 and was 20.6% in 2018, making the current level a more than four‑fold increase from that trough. Elevated disease rates were also found among miners with as few as 15 years underground, a level not seen in nearly four decades.

The rise is linked to increased exposure to respirable crystalline silica as mining shifts from thick coal seams to thinner seams that require cutting through quartz‑rich rock. NIOSH screened 280 veteran miners over the past five years, finding 91 positive cases and extrapolating the regional estimate. The disease threatens workers’ ability to earn a living, imposes caregiving burdens on families, and triggers complex benefits claims. Health providers such as Stone Mountain Health Services in Virginia have assisted more than 2,400 miners with testing, treatment and legal support. The issue coincides with the 2024 Silica Dust Regulation Act and ongoing debates over funding for coal‑related health programs.