Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-30 (of 42 Records) |
Query Trace: Halldin CN[original query] |
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Occupational safety and health of women in mining
Eiter BM , Dugdale ZJ , Robinson T , Nixon CT , Lawson H , Halldin CN , Stazick C . J Womens Health (Larchmt) 2023 32 (4) 388-395 The mining industry plays a critical role in the U.S. economy, with active mines in every state producing materials such as those used to construct houses and roads, make medicines, and manufacture cars and electronics. Throughout its history, mining has been a male-dominated industry. Recent estimates indicate that between 10% and 17% of miners are women. Previous occupational safety and health (OSH) research has focused primarily on the male experience. In more recent years, the mining industry has engaged in efforts to increase workforce diversity through the recruitment and retention of women miners. To meet the needs of a diverse workforce, it is critically important to identify OSH concerns that are unique to populations that have been understudied and to develop work-related policies and practices that improve their work experiences and health outcomes. The purpose of this article is to describe the specific OSH challenges women as miners face and to discuss how the National Institute for Occupational Safety and Health's (NIOSH) Mining Program is situated to address these challenges through its Mining Program Strategic Plan. |
Increased odds of mortality from non-malignant respiratory disease and lung cancer are highest among US coal miners born after 1939
Almberg KS , Halldin CN , Friedman LS , Go LHT , Rose CS , Hall NB , Cohen RA . Occup Environ Med 2023 80 (3) 121-128 OBJECTIVES: Coal miners suffer increased mortality from non-malignant respiratory diseases (NMRD), including pneumoconioses and chronic obstructive pulmonary disease, compared with the US population. We characterised mortality trends from NMRD, lung cancer and ischaemic heart disease (IHD) using data from the Federal Black Lung Program, National Coal Workers' Health Surveillance Program and the National Death Index. METHODS: We compared mortality ORs (MORs) for NMRD, lung cancer and IHD in former US coal miners to US white males. MORs were computed for the study period 1979-2017 by birth cohort (<1920, 1920-1929, 1930-1939, ≥1940), with a subanalysis restricted to Central Appalachia. RESULTS: The study population totalled 235 550 deceased miners, aged >45 years. Odds of death from NMRD and lung cancer across all miner birth cohorts averaged twice those of US males. In Central Appalachia, MORs significantly increased across birth cohorts. There was an eightfold increase in odds of death from NMRD among miners born after 1940 (MOR(BC≥1940) 8.25; 95% CI 7.67 to 8.87). Miners with progressive massive fibrosis (PMF) were younger at death than those without PMF (74 vs 78 years; p<0.0001). We observed a pattern of reduced MORs from IHD in coal miners compared with national and regional counterparts. CONCLUSION: US coal miners have excess mortality from NMRD and lung cancer compared with total US and Appalachian populations. Mortality is highest in the most recent birth cohorts, perhaps reflecting increased rates of severe pneumoconiosis. |
Postexposure progression of pneumoconiosis among former Appalachian coal miners
Hall NB , Blackley DJ , Markle T , Crum JB , Halldin CN , Laney AS . Am J Ind Med 2022 65 (12) 953-958 BACKGROUND: The prevalence of pneumoconiosis among working United States underground coal miners has been increasing for the past two decades, with the highest rates of disease observed among miners in the central Appalachian states of Kentucky, Virginia, and West Virginia. Surveillance for this disease in the United States focuses on working coal miners, who continue to be occupationally exposed to dust. This study examines the radiographic evidence for postexposure progression of pneumoconiosis in a population of former coal miners no longer occupationally exposed to coal mine dust who were seen at a community radiology clinic in eastern Kentucky. METHODS: Data were obtained and analyzed from clinical records of former coal miners who had a clinic encounter during January 1, 2017-August 1, 2019, a recorded final year of employment, and ≥2 postemployment digital chest radiographs. Radiographs were classified according to the International Labour Office guidelines by at least two B Readers. A final summary pneumoconiosis severity score (range, 0-13), accounting for both small and large opacities, was assigned to each chest radiograph. Progression was defined as an increase in severity score between a miner's radiographs over time. RESULTS: Data for 130 former coal miners were analyzed. All miners were male and most (n = 114, 88%) had worked primarily in Kentucky. Information on race/ethnicity was not available. The most common job types were roof bolters (n = 51, 39%) and continuous miner operators (n = 46, 35%). Forty-one (31.5%) miners had evidence of radiographic disease progression after leaving the workforce, with a median of 3.6 years between first and latest postretirement radiograph. A total of 80 (62%) miners had evidence of pneumoconiosis on their latest radiograph, and two-thirds (n = 53) of these were classified as progressive massive fibrosis (PMF), the most severe form of the disease. CONCLUSIONS: Postexposure progression can occur in former coal miners, emphasizing the potential benefits of continued radiographic follow-up postemployment. In addition to participating in disease screening throughout their careers to detect pneumoconiosis early and facilitate intervention, radiographic follow-up of former coal miners can identify new or progressive radiographic findings even after workplace exposure to respirable coal mine dust ends. Identification of progressive pneumoconiosis in former miners has potential implications for clinical management and eligibility for disability compensation. |
Respiratory health of American Indian and Alaska Native coal miners participating in the Coal Workers' Health Surveillance Program, 2014-2019
Hall NB , Nye MJ , Blackley DJ , Scott Laney A , Mazurek JM , Halldin CN . Am J Ind Med 2022 65 (3) 162-165 BACKGROUND: In 2014, a federal rule reduced occupational exposure limits to coal mine dust and expanded medical surveillance eligibility beyond underground miners to surface and contract coal miners. This expansion may have provided an opportunity for more American Indian and Alaska Native (AI/AN) coal miners to participate in screening, since many surface coal mines are located near AI/AN communities and may employ AI/AN miners. Therefore we sought to better understand the respiratory health of AI/AN coal miners by characterizing prevalence of coal workers' pneumoconiosis (CWP), progressive massive fibrosis (PMF), and abnormal lung function in this population. METHODS: Descriptive analysis of 1405 chest radiographs and 627 spirometry test results for AI/AN miners who participated in the Coal Workers' Health Surveillance Program (CWHSP) during 2014-2019 was conducted. RESULTS: Most AI/AN miners (0-25+ years of tenure) were western United States residents (82.3%) and active surface miners (76.9%) with no underground tenure. Among miners with at least 10 years of tenure, prevalence of CWP was 3.0%, and of PMF was 0.3%. Lung function abnormalities were seen in 9.0% with primarily restrictive patterns. CONCLUSIONS: The prevalence of CWP, PMF, and lung function abnormality among active and former AI/AN coal miners was higher than seen in a larger CWHSP study of active western miners working primarily underground with 10+ years of tenure. Interventions that eliminate or control coal mine dust exposure, identify miners with CWP early, and limit respiratory disease progression and complications remain vital for eliminating the preventable adverse health effects of coal mining. Comprehensive demographic data on the coal mining workforce are needed to improve CWHSP participation assessment. |
Electronic health records and pulmonary function data: Developing an interoperability roadmap. An Official American Thoracic Society Workshop Report
McCormack MC , Bascom R , Brandt M , Burgos F , Butler S , Caggiano C , Dimmock AEF , Fineberg A , Goldstein J , Guzman FC , Halldin CN , Johnson JD , Kerby GS , Krishnan JA , Kurth L , Morgan G , Mularski RA , Pasquale CB , Ryu J , Sinclair T , Stachowicz NF , Taite A , Tilles J , Truta JR , Weissman DN , Wu TD , Yawn BP , Drummond MB . Ann Am Thorac Soc 2021 18 (1) 1-11 A workshop "Electronic Health Records and Pulmonary Function Data: Developing an Interoperability Roadmap" was held at the American Thoracic Society 2019 International Conference. "Interoperability" is defined as is the ability of different information-technology systems and software applications to directly communicate, exchange data, and use the information that has been exchanged. At present, pulmonary function test (PFT) equipment is not required to be interoperable with other clinical data systems, including electronic health records (EHRs). For this workshop, we assembled a diverse group of experts and stakeholders, including representatives from patient-advocacy groups, adult and pediatric general and pulmonary medicine, informatics, government and healthcare organizations, pulmonary function laboratories, and EHR and PFT equipment and software companies. The participants were tasked with two overarching Aobjectives: 1) identifying the key obstacles to achieving interoperability of PFT systems and the EHR and 2) recommending solutions to the identified obstacles. Successful interoperability of PFT data with the EHR impacts the full scope of individual patient health and clinical care, population health, and research. The existing EHR-PFT device platforms lack sufficient data standardization to promote interoperability. Cost is a major obstacle to PFT-EHR interoperability, and incentives are insufficient to justify the needed investment. The current vendor-EHR system lacks sufficient flexibility, thereby impeding interoperability. To advance the goal of achieving interoperability, next steps include identifying and standardizing priority PFT data elements. To increase the motivation of stakeholders to invest in this effort, it is necessary to demonstrate the benefits of PFT interoperability across patient care and population health. |
Assessment of pneumoconiosis in surface coal miners after implementation of a national radiographic surveillance program, United States, 2014-2019
Hall NB , Halldin CN , Blackley DJ , Laney AS . Am J Ind Med 2020 63 (12) 1104-1108 BACKGROUND: Pneumoconiosis can occur in surface coal miners. The Coal Workers' Health Surveillance Program (CWHSP) has only included surface coal miners as part of its regular disease surveillance since 2014. This analysis identifies the prevalence of pneumoconiosis among working surface coal miners participating in the CWHSP since their initial inclusion, through 2019. METHODS: Working surface coal miners who had chest radiographs through the CWHSP from January 1, 2014 through December 31, 2019 were included in this analysis. Demographic information, mining tenure and occupation, and radiographic classifications according to the International Labour Office system were included from each miner's most recent encounter with the CWHSP. Prevalence ratios were calculated comparing the prevalence of the disease by region and occupation by log-binomial regression. RESULTS: Pneumoconiosis was present in 109 (1.6%) surface coal miners, including 12 miners with progressive massive fibrosis, the most severe form of the disease. After taking surface mining tenure into account, surface miners in Central Appalachia (prevalence ratio [PR], 3.2; 95% confidence interval [CI], 2.2-4.7) and surface miners who worked as a driller or blaster (PR, 2.1; 95% CI, 1.3-3.5) were at increased risk of pneumoconiosis. CONCLUSION: The occurrence of pneumoconiosis in surface coal miners supports including them within a systematic respiratory health surveillance program. The current surveillance findings are consistent with past findings of pneumoconiosis, particularly silicosis, in surface mining occupations such as drilling and blasting. |
Transplantation for work-related lung disease in the USA
Blackley DJ , Halldin CN , Hayanga JWA , Laney AS . Occup Environ Med 2020 77 (11) 790-794 OBJECTIVES: Work-related lung diseases (WRLDs) are entirely preventable. To assess the impact of WRLDs on the US transplant system, we identified adult lung transplant recipients with a WRLD diagnosis specified at the time of transplant to describe demographic, payer and clinical characteristics of these patients and to assess post-transplant survival. METHODS: Using US registry data from 1991 to 2018, we identified lung transplant recipients with WRLDs including coal workers' pneumoconiosis, silicosis, asbestosis, metal pneumoconiosis and berylliosis. RESULTS: The frequency of WRLD-associated transplants has increased over time. Among 230 lung transplants for WRLD, a majority were performed since 2009; 79 were for coal workers' pneumoconiosis and 78 were for silicosis. Patients with coal workers' pneumoconiosis were predominantly from West Virginia (n=31), Kentucky (n=23) or Virginia (n=10). States with the highest number of patients with silicosis transplant were Pennsylvania (n=12) and West Virginia (n=8). Patients with metal pneumoconiosis and asbestosis had the lowest and highest mean age at transplant (48.8 and 62.1 years). Median post-transplant survival was 8.2 years for patients with asbestosis, 6.6 years for coal workers' pneumoconiosis and 7.8 years for silicosis. Risk of death among patients with silicosis, coal workers' pneumoconiosis and asbestosis did not differ when compared with patients with idiopathic pulmonary fibrosis. CONCLUSIONS: Lung transplants for WRLDs are increasingly common, indicating a need for primary prevention and surveillance in high-risk occupations. Collection of patient occupational history by the registry could enhance case identification and inform prevention strategies. |
Pneumoconiosis progression patterns in US coal miner participants of a job transfer programme designed to prevent progression of disease
Hall NB , Blackley DJ , Halldin CN , Laney AS . Occup Environ Med 2020 77 (6) 402-406 OBJECTIVES: Pneumoconiosis prevalence and severity among US coal miners has been increasing for the past 20 years. An examination of the current approaches to primary and secondary prevention efforts is warranted. One method of secondary prevention is the Mine Safety and Health Administration-administered part 90 option programme where US coal miners with radiographic evidence of pneumoconiosis can exercise their right to be placed in a less dusty area of the mine. This study focuses on characterising the progression of disease among US coal miners who participated in the National Institute for Occupational Safety and Health-administered Coal Workers' Health Surveillance Programme (CWHSP) and exercised their part 90 job transfer option. METHODS: Chest radiograph classifications of working underground coal miners who exercised their part 90 job transfer option during 1 January 1986 to 21 November 2016 and participated in the CWHSP during 1 January 1981 to 19 March 2019 were analysed. RESULTS: 513 miners exercised their part 90 option and participated in the CWHSP at least once during this time period. Of the 149 miners with >/=2 radiographs available, 48 (32%) showed progression after exercising part 90 and had more severe disease prior to exercising, compared with miners who did not progress (severity score of 2.8 vs 1.7, p=0.0002). CONCLUSION: The part 90 job transfer option programme is not routinely used as intended to prevent progression of pneumoconiosis among US coal miners. The one-third of miners who participated in part 90 and continued to progress, exercised their part 90 option at a later stage of disease compared with non-progressors. |
Prevalence of spirometry-defined airflow obstruction in never-smoking working US coal miners by pneumoconiosis status
Kurth L , Laney AS , Blackley DJ , Halldin CN . Occup Environ Med 2020 77 (4) [Epub ahead of print] Introduction: This study estimated the prevalence of spirometry-defined airflow obstruction and coal workers' pneumoconiosis (CWP) among never-smoking coal miners participating in the National Institute for Occupational Safety and Health (NIOSH) Coal Workers' Health Surveillance Program (CWHSP). Methods: Data were from working miners screened by a CWHSP mobile unit who had valid spirometry and chest radiography results. Spirometry-defined airflow obstruction was determined when the ratio of forced expiratory volume in the first second to forced vital capacity is less than the lower limit of normal. Chest radiographs were classified according to the International Labour Office system to identify pneumoconiosis, including the most severe form of pneumoconiosis, progressive massive fibrosis (PMF). Results: Prevalence of airflow obstruction among never- smoking coal miners in this sample was 7.7% overall, 16.4% among miners with CWP and 32.3% among miners with PMF. Airflow obstruction was significantly associated with CWP and PMF. Conclusions: There was a higher prevalence of airflow obstruction among never-smoking coal miners with pneumoconiosis compared with those without pneumoconiosis. these findings support prior research on airflow obstruction and smoking and show pneumoconiosis might present with an obstructive pattern regardless of smoking status. |
Current Review of Pneumoconiosis Among US Coal Miners
Hall NB , Blackley DJ , Halldin CN , Laney AS . Curr Environ Health Rep 2019 6 (3) 137-147 PURPOSE OF REVIEW: This review summarizes recent research on pneumoconiosis in coal workers following the identification of the resurgence of this disease among US coal miners in the early 2000s. We describe the impact of this research and how this has led to increased public attention, benefitting affected miners. RECENT FINDINGS: The latest research shows that the prevalence of pneumoconiosis, including progressive massive fibrosis, continues to increase, especially in central Appalachia. Contributing factors may include mining of thin coal seams or cutting rock to access coal, which may expose miners to coal mine dust with a higher content of silica and silicates than in the past. The impact of recently implemented changes, such as the reduced occupational exposure limit for respirable coal mine dust and the introduction of continuous personal dust monitors, will likely take years to appropriately evaluate. |
The NIOSH B Reader Certification Program-An Update Report (1987-2018) and Future Directions
Halldin CN , Hale J , Weissman D , Attfield M , Parker JE , Petsonk E , Cohen R , Markle T , Blackley D , Wolfe A , Tallaksen R , Laney AS . J Occup Environ Med 2019 61 (12) 1045-1051 OBJECTIVE: The NIOSH B Reader Program provides the opportunity for physicians to demonstrate proficiency in the International Labour Office (ILO) system for classifying radiographs of pneumoconioses. We summarize trends in participation and examinee attributes and performance during 1987-2018. METHODS: Since 1987, NIOSH has maintained details of examinees and examinations. Attributes of examinees and their examination performance were summarized. Simple linear regression was used in trend analysis of passing rates over time. RESULTS: The mean passing rate for certification and recertification for the study period was 40.4%, and 82.6%, respectively. Since the mid-1990 s, the number of B Readers has declined and the mean age and years certified has increased. CONCLUSIONS: To address the declining B Reader population, NIOSH is currently taking steps to modernize the program and offer more opportunities for training and testing. |
Current review of pneumoconiosis among US coal miners
Hall NB , Blackley DJ , Halldin CN , Laney AS . Curr Environ Health Rep 2019 PURPOSE OF REVIEW: This review summarizes recent research on pneumoconiosis in coal workers following the identification of the resurgence of this disease among US coal miners in the early 2000s. We describe the impact of this research and how this has led to increased public attention, benefitting affected miners. RECENT FINDINGS: The latest research shows that the prevalence of pneumoconiosis, including progressive massive fibrosis, continues to increase, especially in central Appalachia. Contributing factors may include mining of thin coal seams or cutting rock to access coal, which may expose miners to coal mine dust with a higher content of silica and silicates than in the past. The impact of recently implemented changes, such as the reduced occupational exposure limit for respirable coal mine dust and the introduction of continuous personal dust monitors, will likely take years to appropriately evaluate. |
Patterns of progressive massive fibrosis on modern coal miner chest radiographs
Halldin CN , Blackley DJ , Markle T , Cohen RA , Laney AS . Arch Environ Occup Health 2019 75 (3) 1-7 Clinical teaching generally asserts that large opacities of progressive massive fibrosis (PMF) on chest radiographs present primarily bilaterally in the upper lung zones, and with an elevated background profusion of small opacities. However, the contemporary basis for these descriptions is limited. Radiographs taken for the Coal Workers' Health Surveillance Program during 2000-2015 and previously determined to have large opacities ("PMF radiographs", n = 204), and a random sample previously deemed free of large opacities (n =22), were independently reevaluated by three National Institute for Occupational Safety and Health (NIOSH) B Readers. Large opacities were noted primarily in the upper right (41%) or upper left (28%) lung zone, but 31% were in middle or lower zones. Unilateral involvement was observed in 34% of readings, with right lung predominance (82%). The median small opacity profusion category for the radiographs with PMF was 2/1. The number of large opacities was not correlated with small opacity profusion category. The "classic" descriptions of PMF as bilateral, associated with elevated background profusions of small pneumoconiotic opacities, were each absent in a third of miners. |
Continued increase in prevalence of r-type opacities among underground coal miners in the USA
Hall NB , Blackley DJ , Halldin CN , Laney AS . Occup Environ Med 2019 76 (7) 479-481 INTRODUCTION: Respirable crystalline silica exposure has been implicated in the resurgence of coal workers' pneumoconiosis (CWP) in the USA. A 2010 report found an increasing prevalence of r-type opacities, which are associated with silicosis lung pathology, on the radiographs of working underground coal miners in central Appalachia. This analysis updates that report by assessing the prevalence of r-type opacities during 2010-2018 compared with earlier decades. METHODS: Data from the Coal Workers' Health Surveillance Program were used to calculate the prevalence of r-type opacities on radiographs of working underground coal miners. The data were restricted to radiographs taken during 1 January 1980 to 15 September 2018. The presence of r-type opacities was defined as an r-type classification for either the primary or secondary shape/size of small opacities. Prevalence ratios for r-type opacities were calculated using log binomial regression. RESULTS: Radiograph classifications for 106 506 miners were included in analysis. For the USA overall, the prevalence of r-type opacities among miners with radiographs taken during 2010-2018 compared with 1980-1989 has increased (PR 2.4; 95% CI 1.9 to 3.0). For central Appalachia, the proportion of r-type opacities observed increased when comparing 1980-1989 to 2010-2018 (PR 6.0; 95% CI 4.6 to 7.9). CONCLUSIONS: The prevalence of r-type opacities on the radiographs of Appalachian underground coal miners continues to increase, implicating exposure to crystalline silica in respirable coal mine dust. The current findings underscore the importance of monitoring and controlling exposure to silica in coal mines. |
Work practices and respiratory health status of Appalachian coal miners with progressive massive fibrosis
Reynolds LE , Blackley DJ , Colinet JF , Potts JD , Storey E , Short C , Carson R , Clark KA , Laney AS , Halldin CN . J Occup Environ Med 2018 60 (11) e575-e581 OBJECTIVE: To characterize workplace practices and respiratory health among coal miners with large opacities consistent with progressive massive fibrosis (PMF) who received care at a federally-funded black lung clinic network in Virginia. METHODS: Participants were interviewed about their workplace practices and respiratory health. Medical records were reviewed. RESULTS: Nineteen former coal miners were included. Miners reported cutting rock, working downwind of dust-generating equipment, non-adherence to mine ventilation plans (including dust controls), improper sampling of respirable coal mine dust exposures, working after developing respiratory illness, and suffering from debilitating respiratory symptoms. CONCLUSIONS: Consistent themes of suboptimal workplace practices contributing to development of PMF emerged during the interviews. Some of the practices reported were unsafe and unacceptable. Further research is needed to determine the prevalence of these factors and how best to address them. |
Progressive massive fibrosis resurgence identified in U.S. coal miners filing for black lung benefits, 1970-2016
Almberg KS , Halldin CN , Blackley DJ , Laney AS , Storey E , Rose CS , Go LHT , Cohen RA . Ann Am Thorac Soc 2018 15 (12) 1420-1426 RATIONALE: There has been a resurgence of progressive massive fibrosis (PMF) in the United States, particularly among central Appalachian miners. OBJECTIVES: We characterized the proportion of PMF among former U.S. coal miners applying for Federal Black Lung Program benefits, 1970-2016. METHODS: Data from the U.S. Department of Labor were used to characterize trends in proportion of PMF cases, defined as an approved black lung claim with a determination of PMF, among all miners who filed for federal benefits between January 1, 1970 and December 31, 2016. Joinpoint, logistic, and linear regression models were used to identify changes in the proportion of claimants with PMF over time. MEASUREMENTS AND MAIN RESULTS: There were 4,679 unique PMF cases among claimants for federal black lung benefits between 1970 - 2016, with 2,474 miners determined to have PMF since 1996. The number of PMF cases among Federal Black Lung Program claimants fell from 404 (0.5% of claimants) in 1978 to a low of 18 cases (0.6%) in 1988, then increased to 353 cases (8.3%) in 2014. The proportion of federal black lung benefits claimants with PMF has been increasing since 1978 (0.06% APC; 95%CI 0.05%, 0.07%; p < .0001), and began increasing at a significantly increased rate after 1996 (0.26% APC; 95% CI 0.25%, 0.28%; p < .0001). Most miners with PMF (84%) last mined in West Virginia, Kentucky, Pennsylvania, or Virginia. Since 1970, the proportion of claimants with PMF has increased significantly among miners who last worked in Kentucky (16.6% APC; 95%CI 16.5%, 16.7%), Pennsylvania (4.7% APC; 95%CI 4.6%, 4.8%), Tennessee (16.1% APC; 95%CI 15.7%, 16.4%), West Virginia (16.8% APC; 95%CI 16.6%, 16.9%), and most sharply among miners last working in Virginia (31.5% APC; 95%CI 31.2%, 31.7%), where in 2009, over 17% of claimants received a PMF determination. The proportion of PMF determinations for the rest of the U.S. have not exceeded 4%. CONCLUSIONS: There has been a resurgence of PMF, particularly in central Appalachian miners. The resurgence of this preventable disease points to the need for improved primary and secondary prevention of dust-related lung disease in U.S. coal miners. |
Continued increase in prevalence of coal workers' pneumoconiosis in the United States, 1970-2017
Blackley DJ , Halldin CN , Laney AS . Am J Public Health 2018 108 (9) e1-e3 OBJECTIVES: To update prevalence estimates for coal workers' pneumoconiosis (CWP) among working underground coal miners in the United States. METHODS: We conducted a prevalence study using radiographs collected from 1970 to 2017. We classified each radiograph using international standards. We defined CWP as the presence of small opacities, with profusion greater than or equal to subcategory 1/0, or the presence of a large opacity larger than 1 centimeter. RESULTS: Following a low point in the late 1990s, the national prevalence of CWP in miners with 25 years or more of tenure now exceeds 10%. In central Appalachia (Kentucky, Virginia, West Virginia), 20.6% of long-tenured miners have CWP. When we excluded miners from central Appalachia, the prevalence for the remainder of the United States was lower, but an increase since 2000 remains evident. CONCLUSIONS: The national prevalence of CWP among working coal miners is increasing. This increase is most pronounced in central Appalachia. Current CWP prevalence estimates will likely be reflected in future trends for severe and disabling disease, including progressive massive fibrosis. Public Health Implications. Recently enacted protections to prevent coal mine dust exposure and identify CWP at its early stage remain essential to protect US coal miners. (Am J Public Health. Published online ahead of print July 19, 2018: e1-e3. doi:10.2105/AJPH.2018.304517). |
Continued increase in lung transplantation for coal workers' pneumoconiosis in the United States
Blackley DJ , Halldin CN , Laney AS . Am J Ind Med 2018 61 (7) 621-624 BACKGROUND: Severe coal workers' pneumoconiosis (CWP) is increasingly common, and sometimes requires lung transplantation. METHODS: Using Organ Procurement and Transplantation Network data, we updated the trend for CWP-related lung transplants, described CWP patients who have been waitlisted but not transplanted, and characterized the primary payer of medical costs for CWP-related and other occupational lung disease transplants. RESULTS: There have been at least 62 CWP-related lung transplants; 49 (79%) occurred in the last decade. The rate of these procedures has also increased. Twenty-seven patients were waitlisted but did not receive a transplant. Compared to other occupational lung diseases, transplants for CWP were more likely to be paid for by public insurance. CONCLUSIONS: The increase in the frequency and rate of lung transplantation for CWP is consistent with the rising prevalence of severe CWP among U.S. coal miners. Effective exposure controls and identification of early stage CWP remain essential for protecting these workers. |
Interstitial lung diseases in the U.S. mining industry: Using MSHA data to examine trends and the prevention effects of compliance with health regulations, 1996-2015
Yorio PL , Laney AS , Halldin CN , Blackley DJ , Moore SM , Wizner K , Radonovich LJ , Greenawald LA . Risk Anal 2018 38 (9) 1962-1971 Given the recent increase in dust-induced lung disease among U.S. coal miners and the respiratory hazards encountered across the U.S. mining industry, it is important to enhance an understanding of lung disease trends and the organizational contexts that precede these events. In addition to exploring overall trends reported to the Mine Safety and Health Administration (MSHA), the current study uses MSHA's enforcement database to examine whether or not compliance with health regulations resulted in fewer mine-level counts of these diseases over time. The findings suggest that interstitial lung diseases were more prevalent in coal mines compared to other mining commodities, in Appalachian coal mines compared to the rest of the United States, and in underground compared to surface coal mines. Mines that followed a relevant subset of MSHA's health regulations were less likely to report a lung disease over time. The findings are discussed from a lung disease prevention strategy perspective. |
Progressive massive fibrosis in coal miners from 3 clinics in Virginia
Blackley DJ , Reynolds LE , Short C , Carson R , Storey E , Halldin CN , Laney AS . JAMA 2018 319 (5) 500-501 This study describes the demographic and radiographic characteristics of 416 coal miners with progressive massive pulmonary fibrosis (PMF) identified by pneumoconiosis screening as part of the US Coal Workers' Health Surveillance Program. |
Coal miner participation in a job transfer program designed to prevent progression of pneumoconiosis, United States, 1986-2016
Reynolds L , Halldin CN , Laney AS , Blackley DJ . Arch Environ Occup Health 2017 73 (6) 0 The Part 90 program was designed to prevent progression of pneumoconiosis in U.S. coal miners by establishing their right to transfer to a less dusty job in the mine. We calculated the proportion of Part 90-eligible miners who participated during 1986-2016, examined participation by region, and compared characteristics of miners by participation status. Of the 3,547 eligible miners, 14.4% exercised their Part 90 option. Miners working in states outside central Appalachia, and those with more severe pneumoconiosis, were more likely to participate. The primary goal of respiratory health surveillance of coal miners is early detection of disease so that preventive action can be taken. Future studies should seek to better understand factors influencing Part 90 program participation. |
Radiographic features of importance in the National Institute for Occupational Safety and Health-administered Coal Workers' Health Surveillance Program: characterising the use of the 'other symbols'
Halldin CN , Hale JM , Blackley DJ , Laney AS . BMJ Open 2017 7 (8) e015876 OBJECTIVE: The National Institute for Occupation Safety and Health-administered Coal Workers' Health Surveillance Program (CWHSP) provides radiographic pneumoconiosis screening for US coal miners. Radiographs are classified by readers according to International Labour Office criteria. In addition to pneumoconiotic parenchymal and pleural lung abnormalities, readers document radiographic features of importance (other symbols). Other symbols are not meant to imply a diagnosis or interpretation but are relevant as they provide information beyond a pneumoconiosis classification for features related to dust exposure and other aetiologies. Our objective was to summarise other symbol data from 48 years of CWHSP participants. METHODS: Chest radiograph classifications obtained from CWHSP participants between July 1968 and July 2016 were analysed. Any 'other symbol' indication from any of the readings were counted. Frequencies were tabulated by individual reader and those identified by any reader. RESULTS: Of the 469 922 radiographs included in this study, nearly 15% had at least one reader identify a radiographic feature of importance. The most commonly identified other symbol was cancer (excluding mesothelioma) (6.83%), followed by emphysema (1.68%). Some features were rarely identified over the 48 years of data collection such as rheumatoid pneumoconiosis (n=46), pneumothorax (n=32), mesothelioma (n=12) and rounded atelectasis (n=4). CONCLUSIONS: This is the largest study to date describing radiographic features of importance as part of routine chest radiographic surveillance. While these symbols are not diagnostic they can be used to describe features associated with dust exposure. One of the most commonly identified radiographic features in our population is emphysema which is associated with respirable dust exposure. These results can be compared with other dust exposed populations. |
Linking compensation and health surveillance data sets to improve knowledge of US coal miners' health
Almberg KS , Cohen RA , Blackley DJ , Laney AS , Storey E , Halldin CN . J Occup Environ Med 2017 59 (10) 930-934 OBJECTIVE: Increase knowledge of US coal miners' respiratory health by linking data from the black lung benefits program (BLBP) and the coal workers' health surveillance program (CWHSP). METHODS: BLBP claims data from 2000 through 2013 was linked to CWHSP data from 1970 through 2016. RESULTS: Overall, 273,644 miners participated in CWHSP, 37,548 in BLBP, and 22,903 in both programs. Median age of miners at their time of first/only participation in CWHSP was 28 and 32 years, respectively. BLBP claimants were older (median age 59). Thirty-nine percent of BLBP claimants had not participated in CWHSP. The relative contributions of states to participation differed between CWHSP and BLBP. For example, Kentucky miners accounted for 18% of CWHSP participants, but 36% of BLPB participants. CONCLUSIONS: Many BLBP claimants never appeared in CWHSP, indicating missed opportunities for secondary prevention. |
Evaluation of high blood pressure and obesity among US coal miners participating in the Enhanced Coal Workers' Health Surveillance Program
Casey ML , Fedan KB , Edwards N , Blackley DJ , Halldin CN , Wolfe AL , Laney AS . J Am Soc Hypertens 2017 11 (8) 541-545 Since 2005, the Enhanced Coal Workers' Health Surveillance Program (ECWHSP) has offered respiratory examinations to coal miners in a mobile examination unit. As little is known about the cardiovascular health of coal miners, we describe the prevalence of high blood pressure (BP) and obesity among ECWHSP participants. During 2015, 1402 ECWHSP health examinations were performed. The prevalence of BP consistent with hypertension (systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg), prehypertension (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg), and hypertensive crisis (systolic BP ≥ 180 mm Hg or diastolic BP ≥ 110 mm Hg) were calculated and compared with the US adult population using standardized morbidity ratios (SMRs). Most participants were male (N = 1317, 94%), White (N = 1303, 93%) and non-Hispanic (N = 1316, 94%). Thirty-one percent (N = 440) of participants had BP in the hypertensive range and 87% (N = 1215) were overweight/obese. Twenty-four participants (2%) had a BP reading consistent with a hypertensive crisis. Prevalence of obesity (52%, SMR = 1.52, 95% confidence interval = 1.41-1.64) and BP consistent with hypertension (31%, SMR = 1.60, 95% confidence interval = 1.45-1.76) was higher than the US adult population.The prevalence of obesity and BP consistent with hypertension in this population of coal miners is substantial, indicating a need for cardiovascular health interventions in coal mining communities. |
Respiratory morbidity among U.S. coal miners in states outside of central Appalachia
Reynolds LE , Blackley DJ , Laney AS , Halldin CN . Am J Ind Med 2017 60 (6) 513-517 BACKGROUND: Recent NIOSH publications have focused on the respiratory health of coal miners in central Appalachia, yet 57% of U.S. coal miners work in other regions. We characterized respiratory morbidity in coal miners from these regions. METHODS: Active coal miners working outside of central Appalachia who received chest radiographs and/or spirometry during 2005-2015 were included. Chest radiographs were classified according to International Labour Office standards and spirometry was interpreted using the American Thoracic Society guidelines. Prevalence of coal workers' pneumoconiosis (CWP) and abnormal spirometry were compared by region. RESULTS: A total of 103 (2.1%) miners had CWP. The eastern region had the highest prevalence (3.4%), followed by the western (1.7%), and interior (0.8%) regions. A total of 524 (9.3%) miners had abnormal spirometry. CONCLUSIONS: CWP occurs in all U.S. coal mining regions. Prevalence of CWP was higher in the eastern region, but lower than levels reported in central Appalachia. |
Engineering controls are the most protective means of controlling respirable coal mine dust
Blackley DJ , Halldin CN , Laney AS . Lancet Respir Med 2017 5 (5) e18 We read with interest the Review article1 by Paul Cullinan and colleagues. The authors highlight workplace exposures as substantially contributing to the global burden of respiratory disease. These exposures receive less public health attention than interventions focused on individual lifestyle risks, even though the risks of many workplace exposures, such as respirable coal mine dust, are well characterised and have proven control measures. For example, the authors rightly identify engineering solutions as an important part of the hierarchy of controls for reducing workers’ exposure to coal mine dust. We also agree with the statement later in the Review that the use of personal protective equipment, such as various forms of respirator, occupies the lowest tier of the hierarchy of controls and is reserved for situations in which other methods have failed adequately to control airborne exposures. | In view of this, we are concerned that the statement “Respiratory protective equipment should be used as a primary means of protection” could inaccurately be taken out of context. Use of respiratory protection should not be a primary means of protection against respirable coal mine dust, for the reasons provided subsequently in the Review. Consistent with this approach, a final rule2 published in 2014 by the US Mine Safety and Health Administration requires engineering or environmental controls as the primary means of controlling respirable dust, a position affirmed by the National Institute for Occupational Safety and Health, and one that is consistent with the hierarchy of controls outlined in figure 5 of the Review. As the authors rightly note, severe coal workers’ pneumoconiosis remains a major public health concern, not only in rapidly industrialising nations, but also in developed countries including the USA. In fact, an update3 of coal workers’ medical surveillance (with 3 years of additional data figure 1 from Cullinan and colleagues1) points to a still worsening situation in the central Appalachian region of the USA (figure). |
Pneumoconioses radiographs in a large population of U.S. coal workers: Variability in A reader and B reader classifications by using the International Labour Office Classification
Halldin CN , Blackley DJ , Petsonk EL , Laney AS . Radiology 2017 284 (3) 162437 Purpose To assess the level of concordance between chest radiographic classifications of A and B Readers in a national surveillance program offered to U.S. coal miners over an approximate 36-year period. Materials and Methods The National Institute for Occupational Safety and Health (NIOSH) Coal Workers' Health Surveillance Program (CWHSP) is a surveillance program with nonresearch designation and is exempt from Human Subjects Review Board approval (11-DRDS-NR03). Thirty-six years of data (1979-2015) from the CWHSP were analyzed, which included all conventional screen-film radiographs with a classification by at least one A Reader and one B Reader. Agreement was assessed by using kappa statistics; prevalence ratios were used to describe differences between A and B Reader determinations of image technical quality, small opacity profusion, and presence of large opacities and pleural abnormalities. Results The analysis included 79 185 matched A and B Reader chest radiograph classifications. A majority of both A and B Readers were radiologists (74.2% [213 of 287] vs 64.7% [22 of 34]; P = .04). A and B Readers had minimal agreement on technical image quality (kappa = 0.0796; 95% confidence interval [CI]: 0.07, 0.08) and the distribution of small opacity profusion (subcategory kappa, 0.2352; 95% CI: 0.22, 0.25). A Readers classified more images as "good" quality (prevalence ratio, 1.38; 95% CI: 1.35, 1.41) and identified more pneumoconiosis (prevalence ratio, 1.22; 95% CI: 1.20, 1.23). Conclusion A Readers classified substantially more radiographs with evidence of pneumoconiosis and classified higher small opacity profusion compared with B Readers. These observations reinforce the importance of multiple classifications by readers who have demonstrated ongoing competence in the International Labour Office classification system to ensure accurate radiographic classifications. |
Strengthening the Coal Workers' Health Surveillance Program
Reynolds LE , Wolfe AL , Clark KA , Blackley DJ , Halldin CN , Laney AS , Storey E . J Occup Environ Med 2017 59 (4) e71 In 2014, the Mine Safety and Health Administration (MSHA) issued a final rule1 requiring the National Institute for Occupational Safety and Health (NIOSH) to expand the coal workers’ health surveillance program (CWHSP). Since 1970, when it was established by the Coal Mine Health and Safety Act of 1969, the CWHSP has offered chest radiographs to US coal miners—primarily those working underground—to detect coal workers’ pneumoconiosis (CWP) early and prevent it from progressing to disabling disease. The expansion of the CWHSP adds periodic lung function testing (spirometry) and respiratory health assessment questionnaires, and extends its coverage to include surface coal miners. This will permit the early detection of lung function impairment secondary to chronic obstructive pulmonary disease, an important manifestation of coal mine dust lung disease that is not detected by chest radiography. | On October 24, 2016, in accordance with the MSHA rule, NIOSH published a final rule2 updating medical surveillance for coal miners. NIOSH collaborated with MSHA, mine operators, clinics, medical device manufacturers, and other stakeholders to develop a framework to meet its new mandate. All clinics participating in the CWHSP, including new spirometry clinics, must be approved by NIOSH to ensure clinic personnel are trained, equipment and procedures are standardized, and miners’ health information can be securely collected and transmitted to NIOSH. |
Radiographic disease progression in contemporary US coal miners with progressive massive fibrosis
Laney AS , Blackley DJ , Halldin CN . Occup Environ Med 2017 74 (7) 517-520 INTRODUCTION: Among contemporary US coal miners, there has been an increase in the prevalence and severity of pneumoconiosis, including its advanced form progressive massive fibrosis (PMF). We examine radiographic progression in Coal Workers' Health Surveillance Program (CWHSP) participants. METHODS: CWHSP participants with a final determination of PMF during 1 January 2000-1 October 2016 with at least one prior radiograph in the system were included. We characterised demographics, participation and progression patterns. RESULTS: A total of 192 miners with a PMF determination contributed at least one additional radiograph (total count: 2-10). Mean age at first radiograph was 28.8 years, 162 (84%) worked in Kentucky, Virginia or West Virginia and 169 (88%) worked exclusively underground. A total of 163 (85%) miners had a normal initial radiograph. Mean time from most recent normal radiograph to one with a PMF determination was 20.7 years (range: 1-43) and 27 (17%) progressed to PMF in less than 10 years. DISCUSSION: Dust exposure is the sole cause of this disease, and a substantial number of these miners progressed from normal to PMF in less than a decade. Participation in CWHSP is voluntary, and these findings are influenced by participation patterns, so for many miners it remains unclear how rapidly their disease progressed. The National Institute for Occupational Safety and Health recommends all working miners to participate in radiographic surveillance at 5-year intervals. Improved participation could allow more precise characterisation of the burden and characteristics of pneumoconiosis in US coal miners and provide an important early detection tool to prevent cases of severe disease. |
Misclassification of occupational disease in lung transplant recipients
Blackley DJ , Halldin CN , Cohen RA , Cummings KJ , Storey E , Laney AS . J Heart Lung Transplant 2017 36 (5) 588-590 Data from the United States Organ Procurement and Transplantation Network (OPTN) registry have been analyzed in recent years to assess post–lung transplant (LT) survival in occupational lung disease patients.1–3 Registry data include diagnosis codes with limited specificity; each patient is assigned a diagnosis code at waitlist candidacy, at listing, and at LT, and these codes can differ. The use of both numeric and free-text data can produce incompatible or unlikely diagnosis code pairings (such as a numeric code for idiopathic pulmonary fibrosis with a paired free-text entry of “silicosis”). The resulting misclassification could bias findings related to patient characteristics, post-LT survival comparisons and other measures used to summarize outcomes. | Diagnosis codes from OPTN data could be inadequate for case finding and may result in missed occupational lung disease cases. Our objective was to identify and describe adult LT recipients documented as having conditions known to be entirely attributable to occupational exposure, and to calculate the proportion of those patients who were assigned an occupational lung disease diagnosis code at LT. |
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