Recent data showing an increase in mortality from coal workers’ pneumoconiosis (CWP) highlight the need for early detection and diagnosis of the disease.
Identifying exposure to coal dust is particularly important, said David N. Weissman, MD, FCCP, Director of the Respiratory Health Division at the National Institute for Occupational Safety and Health (NIOSH), part of the US Centers for Disease Control and Prevention (CDC).
The CDC’s Coal Workers’ Health Surveillance Program offers health screening for early detection at no cost to miners. It informs miners with findings consistent with CWP—widely known as black lung disease—about their rights to work in a low-dust environment to help protect their lungs. These workers must be moved to a less dusty environment with no loss in pay or benefits.
“That’s a very concrete benefit of diagnosing coal workers’ pneumoconiosis in someone who doesn’t have advanced disease,” Dr. Weissman said. “If they move to a lower-dust job, they can continue to make their income and not have as heavy an exposure. We have data to show that people who take advantage [of changing jobs] do better from the standpoint of their lung health.”
Dr. Weissman is senior author of an exploratory analysis of CWP-associated deaths using death data for 2020 to 2023—the most recent years available with coded information on decedent’s industry and occupation—from the National Vital Statistics System.1 The annual number of CWP-associated deaths rose from 370 in 2020 to 462 in 2023, for an annualized age-adjusted death rate of 1.3 per 1 million people. The highest rate of CWP deaths occurred in coal mining and construction, concentrated among mining machine operators.1 An earlier analysis found a declining trend in CWP deaths from 1999 (1,002 deaths and 4.7 per million) to 2018 (305 deaths and 1.0 per million).
“No one should die because they went to work and did their job,” said Drew Harris, MD, FCCP, Associate Professor of Pulmonary and Critical Care Medicine at the University of Virginia, Medical Director of the Black Lung Program at Stone Mountain Health Services, and former Editor in Chief of CHEST Advocates. “These are not statistics. They are fathers, grandfathers, church deacons, youth baseball coaches—hardworking people whose labor powered this country for generations. Their families and communities shoulder the consequences of a disease that should not still exist in modern America.”
But CWP persists, and reported mortality has reached 1,754 in the early 2020s alone. Still, early detection and treatment may help slow progression.
“The number one thing clinicians need to do is to ask their adult patients, even their teenaged patients, about their work history,” Dr. Weissman said. “We recommend a quick screen that could be as simple as asking, ‘What kind of work do you do?’ or, if it’s a retired person, ‘What kind of work did you do during your working years?’
“When you have a disease that could be caused by occupational exposures, such as interstitial lung disease, knowing where they worked and what they may have been exposed to can put you down the path to diagnosis. If you find that occupational exposures could be causing their disease, you have a better chance of diagnosing it and getting the person out of that exposure before it progresses to severe disease.”
The rise in mortality reported in 2025 follows changes in mining methods and technology, Dr. Weissman said. Even though CWP is known as black lung disease due to the black dust inhaled by coal miners, the crystalline silica component of dust is an important culprit. Evolving technologies enable the extraction of thinner layers of coal within thicker layers of silica-rich rock.
“Coal mine dust is a complicated mixture of coal and crystalline silica and other silicate minerals that are found in the rocks,” he said. “Powerful machines chew through the thin seams of coal sandwiched in the rock, and the coal is separated out afterward. The dust miners are exposed to because of these changes in practice is more toxic. There have been more people who have been overexposed based on the larger numbers of people who have gotten severe disease.”
A recent JAMA brief noted that while there are no specific treatments for CWP, exposure control and early detection can reduce morbidity and mortality.2 The Mine Safety and Health Administration (MSHA) tightened regulations in 2014 to reduce allowable respirable coal mine dust exposure levels, require use of continuous personal dust monitors, and expand medical surveillance testing to include spirometry. It also provided medical surveillance to surface coal miners. However, coal miners are permitted to be exposed to silica dust levels that are twice as high as what workers in other industries experience.3
In an effort to reduce these toxic silica dust exposures, MSHA finalized a rule in 2024 to reduce exposure to the respirable crystalline silica component of coal mine dust. But enforcement of this rule has not yet occurred due to ongoing litigation brought on by mining industries.
Increasing political pressure may help, Dr. Harris said, because the stalled MSHA silica dust standard was finalized with the explicit goal of saving miners’ lives.
“Opponents argue that it is too costly or too difficult to enforce,” he said. “The cost of inaction is measured in oxygen tanks, lung transplants, widowed spouses, and 1,754 preventable deaths. The science is clear. The solutions are known. What remains is the will to act.”
In the absence of enforced protections, it’s important to collect occupational history from patients, said Jacek Mazurek, MD, PhD, CDC Respiratory Health Division Surveillance Branch Chief and lead author of the 2025 analysis.
“If you have someone with asthma, as an example, asking about exposures, asking whether pulmonary symptoms improve when they are away from work or get more severe if they are on the job, can save lives,” he said. “Many individuals with CWP did not have mining employment history listed as the longest-held job on their death certificate. Questions about past history of jobs may really help accelerate proper management of patients.”
References
1. Mazurek JM, Dodd KE, Syamlal G, Blackley DJ, Weissman DN. Coal workers’ pneumoconiosis-associated deaths – United States, 2020-2023. MMWR Morb Mortal Wkly Rep. 2025;74(41):627-633. doi:10.15585/mmwr.mm7441a1
2. Rubin R. Black lung disease deaths rising. JAMA. 2026;335(6):481. doi:10.1001/jama.2025.23027
3. Dodson W. Tighter silica rules needed to protect miners from black lung disease. Appalachian Voices. April 14, 2021. https://appvoices.org/2021/04/14/silica-black-lung/
