Coal miners in Central Appalachia are developing black lung disease at rates unseen for decades, with some patients diagnosed in their 30s and 40s. The renewed burden follows years in which dust limits had driven the disease to far lower levels, and it comes as mining has moved deeper into rock that releases silica dust.
A NIOSH study published this month found that one out of three miners in Central Appalachia with more than 25 years in the industry have black lung disease. An analysis published in the American Journal of Respiratory and Critical Care Medicine put the prevalence at 32.5 percent among sampled veteran underground coal miners in Central Appalachia with at least 25 years underground.
The last time prevalence reached 32.5 percent among miners with the same work history was in 1978. Black lung disease had fallen to 7 percent in 1999. The latest findings therefore represent more than a fourfold increase since that low point.
Rates in the region have risen for the past 20 years or more. They have continued to grow since the 2000s, when regulations limiting coal-dust exposure had brought the disease down to very low levels.
Black lung disease, also known as coal workers' pneumoconiosis, is caused by inhaling dust particles. There is no treatment to reverse the lung damage. Progressive massive fibrosis is its most severe form.
At a specialised clinic in Oak Hill, the youngest patient diagnosed with progressive massive fibrosis was 30 years old. John Robinson, who mined coal in south-west Virginia, received a black lung diagnosis at 47. John, a coal miner in West Virginia, is 45 years old and has worked in coal mines for 20 years. He has been diagnosed with coal workers' pneumoconiosis.
The available evidence links the worsening pattern to greater dust exposure. Miners have been forced to bore deeper into rock to extract coal, sending fine silica dust into the air. Silica is 20 times more toxic than coal. Miners are becoming ill more quickly and developing more severe forms of black lung disease than in the past because of greater exposure.
The risk extends beyond coal mining. A study published in the New England Journal of Medicine identified nearly 600 cases of silicosis among countertop fabrication workers in California. It recorded 65 lung transplants and 31 deaths. Silicosis is another occupational lung disease caused by inhaling dust particles.
Recent sampling also suggests continuing problems with workplace exposure. Shelton reviewed silica dust samples reported by MSHA from January to June of this year and found that 17% of the operations sampled had silica dust concentrations above the limit set in the delayed 2024 silica dust rule. Most mines with the highest silica concentrations were in central Appalachia.
Federal protections have been in place since the Coal Mine Health and Safety Act of 1969, which established dust limits and black lung benefits. Yet a GAO report published in May found that the Department of Labor does not monitor whether coal companies provide the medical benefits they are legally required to cover.
Miners in all six of GAO's focus groups reported problems with black lung-related medical benefits. Two groups specifically described difficulty securing medical coverage from the coal companies responsible for it. Among younger miners under 62, nearly one-fourth received only federal black lung benefit payments, averaging $13,400 annually in 2024.
The studies and government findings document a return of severe disease and shortcomings in benefit oversight. They do not establish whether changes in enforcement or particular company practices directly caused the resurgence. The consequences for affected workers are clear: a preventable dust disease is appearing earlier in working lives, with no treatment able to reverse the damage.
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