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The report presents the findings of a literature review ad quantitative analysis conducted under the Black Lung Incidence Study. The study was designed to examine black lung incidence in the United States, exploring both cases and deaths. Within this scope, the study examined whether black lung incidence is higher among specific subpopulations of interest, including miners, mining communities, the Navajo Nation, and residents of Appalachia.

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Key Takeaways

• On average, there are 4.34 cumulative cases (1970-2014) and 3.44 cumulative deaths (1999-2020) attributable to black lung disease per county across the United States. These results are counts and therefore not subject to population size.
• The prevalence of black lung disease is highly concentrated in specific areas of the country, such as Appalachia, where the statistics rise to 28.79 cumulative cases and 10.88 cumulative deaths, on average. 103 counties out of 3,136 report black lung cases during the entire collection period (1970-2014) while 333 counties report black lung deaths (1999-2020). These results are counts and not subject to population size.
• Coal workers’ pneumoconiosis (CWP) prevalence has been increasing in the United States since the 1990s.
• Undercounts of black lung disease in the United States may be attributed to factors including low uptake of Coal Workers’ Health Surveillance Program screenings and low compensation approval rates.
• There are 0.11 black lung cases per 1,000 U.S. residents, or 11 cases per 100,000.
• There are 0.04 black lung deaths per 1,000 U.S. residents, or 4 cases per 100,000.
• Black lung disease is most prevalent among coal counties, especially those that have maintained coal-mining practices since the 1970s and 1980s.
• Appalachia has significantly more black lung cases and deaths than the rest of the United States, both overall and accounting for population size.
• Zero cases and just 10 deaths were reported in the Navajo Nation during the respective collection periods (1970-2014 and 1999-2020). Therefore, hypothesis testing between the Navajo Nation and other regions proved inconclusive. These results may be a function of underreporting in the Navajo Nation.
• There is a correlation between residential coal use and black lung cases and deaths. However, this correlation does not imply a causal relationship between residential use and black lung disease.
• There are significantly more cases and deaths from black lung in residential coal burning areas than other parts of the United States.
• Residential coal burning is likely a confounding factor with other black lung characteristics, such as the number of local underground mines or family members working in the coal industry.

Citation

Summit Consulting. (2023). Black Lung Incidence Study Final Report. Chief Evaluation Office, U.S. Department of Labor.

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The Department of Labor’s (DOL) Chief Evaluation Office (CEO) sponsors independent evaluations and research, primarily conducted by external, third-party contractors in accordance with the Department of Labor Evaluation Policy and CEO’s research development process.