Last data update: Dec 02, 2024. (Total: 48272 publications since 2009)
Records 1-30 (of 53 Records) |
Query Trace: Halldin C[original query] |
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Erratum: Prevalence of airflow obstruction among ever-employed US adults aged 18-79 years by longest held occupation group: National Health and Nutrition Examination Survey 2007-2010
Kurth L , Doney B , Halldin C . Occup Environ Med 2016 73 (9) 637-8 Kurth L, Doney B, Halldin C. Short Report: Prevalence of airflow obstruction among ever-employed US adults aged 18–79 years by longest held occupation group: National Health and Nutrition Examination Survey 2007–2010. Occup Environ Med 2016;73:482–6. | The title that reads: “Prevalence of airflow obstruction among ever-employed US adults aged 18–79 years by longest held occupation group: National Health and Nutrition Examination Survey 2007–2010” should read “Prevalence of airflow obstruction among ever-employed US adults aged 18–79 years by longest held occupation group: National Health and Nutrition Examination Survey 2007–2008”. | All references on page 482 to ‘the 2007–2010 National Health and Nutrition Examination Survey (NHANES)’ and/or ‘2007–2010 NHANES data’ should read ‘the 2007–2008 National Health and Nutrition Examination Survey (NHANES)’ and ‘2007–2008 NHANES data’. | The sentences on page 482 that read “The US population, 18–79 years, was studied using NHANES data from the combined cross-sectional 2007–2008 and 2009–2010 survey cycles. These were the most current NHANES cycles available with longest held occupation and spirometry data” should read “The US population, 18–79 years, was studied using NHANES data from the cross-sectional 2007–2008 survey cycle”. | The sentences on page 483 that read “In the 2007–2010 NHANES, 11 891 persons aged 18–79 years who provided interview data were eligible for the spirometry component of the physical examination. Of those, 1,867 were excluded from spirometry for safety reasons, health reasons, or other reasons, and 501 had poor quality spirometry data” should read “In the 2007–2008 NHANES, 5789 persons aged 18–79 years who provided interview data were eligible for the spirometry component of the physical examination. Of those, 1030 were excluded from spirometry for safety reasons, health reasons, or other reasons, and 246 had poor quality spirometry data”. | The sentence on page 483 that reads “During 2007–2010, 4,172 NHANES participants had valid spirometry, height, and longest held occupation data, and were included in the study” should read “During 2007–2008, 4,172 NHANES participants had valid spirometry, height, and longest held occupation data, and were included in the study”. | The sentence on page 483 that reads “We analyzed NHANES data from 2007 to 2010 and estimated that the prevalence of spirometry-defined airflow obstruction among ever-employed US adults aged 18–79 years was 13.7%” should read “We analyzed NHANES data from 2007 to 2008 and estimated that the prevalence of spirometry-defined airflow obstruction among ever-employed US adults aged 18–79 years was 13.7%”. | The following sentence on page 484 should be deleted: “Even by combining data from the NHANES 2007–2008 and 2009–2010 survey cycles to improve the reliability of prevalence estimates, the prevalence estimates for some occupation groups were unreliable. The inclusion of NHANES occupation data from the 2011–2012 survey cycle, once it is released, may help us compute reliable prevalence estimates for additional occupation groups”. | The sentence on page 484 that reads “The prevalence of spirometry-defined airflow obstruction among ever-employed US adults from 2007 to 2010 varied by demographic characteristics and occupational factors, and was generally…” should read “The prevalence of spirometry-defined airflow obstruction among ever-employed US adults from 2007 to 2008 varied by demographic characteristics and occupational factors, and was generally…”. | The title of Table 1 on page 483 that reads “Age-specific and age-standardised prevalence of airflow obstruction among ever-employed US adults aged 18–79 years by smoking status for selected demographic characteristics and occupational factors––NHANES 2007–2010” should read “Age-specific and age-standardised prevalence of airflow obstruction among ever-employed US adults aged 18–79 years by smoking status for selected demographic characteristics and occupational factors––NHANES 2007–2008”. |
Respirable coal mine dust at surface mines, United States, 1982-2017
Doney BC , Blackley D , Hale JM , Halldin C , Kurth L , Syamlal G , Laney AS . Am J Ind Med 2020 63 (3) 232-239 BACKGROUND: Exposure to respirable coal mine dust can cause pneumoconiosis, an irreversible lung disease that can be debilitating. The mass concentration and quartz mass percent of respirable coal mine dust samples (annually, by occupation, by geographic region) from surface coal mines and surface facilities at U.S. underground mines during 1982-2017 were summarized. METHODS: Mine Safety and Health Administration (MSHA) collected and analyzed data for respirable dust and a subset of the samples were analyzed for quartz content. We calculated the respirable dust and quartz concentration geometric mean, arithmetic mean, and percent of samples exceeding the respirable dust permissible exposure limit (PEL) of 2.0 mg/m3, and the average percent of quartz content in samples. RESULTS: The geometric mean for 288 705 respirable dust samples was 0.17 mg/m(3) with 1.6% of the samples exceeding the 2.0 mg/m(3) PEL. Occupation-specific geometric means for respirable dust in active mining areas were highest among drillers. The geometric mean for respirable dust was higher in central Appalachia compared to the rest of the U.S. The geometric mean for respirable quartz including 54 040 samples was 0.02 mg/m(3) with 15.3% of these samples exceeding the applicable standard (PEL or reduced PEL). Occupation-specific geometric means for respirable quartz were highest among drillers. CONCLUSION: Higher concentrations of respirable dust or quartz in specific coal mining occupations, notably drilling occupations, and in certain U.S. regions, underscores the need for continued surveillance to identify workers at higher risk for pneumoconiosis. |
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. |
Medical claims paid by workers' compensation insurance among US Medicare beneficiaries, 1999-2016
Kurth L , Casey M , Chin B , Mazurek JM , Schleiff P , Halldin C , Blackley DJ . Am J Ind Med 2021 64 (3) 185-191 BACKGROUND: Workers' compensation claims among Medicare beneficiaries have not been described previously. To examine the healthcare burden of work-related injury and illness among Medicare beneficiaries, we assessed the characteristics, healthcare utilization, and financial costs among Medicare beneficiaries with claims for which workers' compensation was the primary payer. METHODS: We extracted final action fee-for-service Medicare claims from 1999 to 2016 where workers' compensation had primary responsibility for claim payment and beneficiary, claim type, diagnoses, and cost information from these claims. RESULTS: During 1999-2016, workers' compensation was the primary payer for 2,010,200 claims among 330,491 Medicare beneficiaries, and 58.7% of these beneficiaries had more than one claim. Carrier claims submitted by noninstitutional providers constituted the majority (94.5%) of claims. Diagnosis codes indicated 19.4% of claims were related to diseases of the musculoskeletal system and connective tissue and 12.9% were related to disease of the circulatory system. Workers' compensation insurance paid $880.4 million for these claims while Medicare paid $269.7 million and beneficiaries paid $37.4 million. CONCLUSIONS: Workers' compensation paid 74% of the total amount to providers for these work-related medical claims among Medicare beneficiaries. Claim diagnoses were similar to those of all workers' compensation claims in the United States. Describing these work-related claims helps identify the healthcare burden due to occupational injury and illness among Medicare beneficiaries resulting from employment and identifies a need for more comprehensive collection and surveillance of work-related medical claims. |
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. |
Causes of death among Federal Black Lung Benefits Program beneficiaries enrolled in Medicare, 1999-2016
Kurth L , Halldin C , Laney AS , Blackley DJ . Am J Ind Med 2020 63 (11) 973-979 BACKGROUND: Coal miners with totally disabling pneumoconiosis are eligible for benefits through the Federal Black Lung Benefits Program (FBLP). We identify the causes of death among Medicare beneficiaries with a claim for which the FBLP was the primary payer and compare these causes of death to all deceased Medicare beneficiaries to better understand elevated death and disease among miners with occupational respiratory exposures. METHODS: From 1999 to 2016 Medicare data, we extracted beneficiary and National Death Index data for 28,003 beneficiaries with an FBLP primary payer claim. We summarized the International Classification of Diseases, Clinical Modification 10th revision-coded underlying causes of death and entity-axis multiple causes of death for 22,242 deceased Medicare beneficiaries with an FBLP primary payer Medicare claim and compared their causes of death to the deceased Medicare beneficiary population. RESULTS: Among deceased FBLP beneficiaries, the three leading underlying causes of death were chronic obstructive pulmonary disease, unspecified (J44.9, 10.1%), atherosclerotic heart disease (I25.1, 9.3%), and coal workers' pneumoconiosis (CWP) (J60, 9.2%). All diseases of the respiratory system combined (J00-J99) were the underlying cause of death for 29.1% of all beneficiaries, with pneumoconioses (J60-J64) as the underlying cause for 11.0% of all beneficiaries. CONCLUSIONS: Coal miners enrolled in Medicare with an FBLP primary payer claim were more likely to have specific respiratory and cardiovascular diseases listed as a cause of death than deceased Medicare beneficiaries overall, and were also more likely to die from CWP or any pneumoconioses. |
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. |
Primary Indicators to Systematically Monitor COVID-19 Mitigation and Response - Kentucky, May 19-July 15, 2020.
Varela K , Scott B , Prather J , Blau E , Rock P , Vaughan A , Halldin C , Griffing S , Pfeiffer H , Hines J , Dirlikov E , Thoroughman D . MMWR Morb Mortal Wkly Rep 2020 69 (34) 1173-1176 State and local health departments in the United States are using various indicators to identify differences in rates of reported coronavirus disease 2019 (COVID-19) and severe COVID-19 outcomes, including hospitalizations and deaths. To inform mitigation efforts, on May 19, 2020, the Kentucky Department for Public Health (KDPH) implemented a reporting system to monitor five indicators of state-level COVID-19 status to assess the ability to safely reopen: 1) composite syndromic surveillance data, 2) the number of new COVID-19 cases,* 3) the number of COVID-19-associated deaths,(†) 4) health care capacity data, and 5) public health capacity for contact tracing (contact tracing capacity). Using standardized methods, KDPH compiles an indicator monitoring report (IMR) to provide daily analysis of these five indicators, which are combined with publicly available data into a user-friendly composite status that KDPH and local policy makers use to assess state-level COVID-19 hazard status. During May 19-July 15, 2020, Kentucky reported 12,742 COVID-19 cases, and 299 COVID-19-related deaths (1). The mean composite state-level hazard status during May 19-July 15 was 2.5 (fair to moderate). IMR review led to county-level hotspot identification (identification of counties meeting criteria for temporal increases in number of cases and incidence) and facilitated collaboration among KDPH and local authorities on decisions regarding mitigation efforts. Kentucky's IMR might easily be adopted by state and local health departments in other jurisdictions to guide decision-making for COVID-19 mitigation, response, and reopening. |
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. |
Medicare claims paid by the Federal Black Lung Benefits Program: U.S. Medicare Beneficiaries, 1999-2016
Kurth L , Casey M , Schleiff P , Halldin C , Mazurek J , Blackley D . J Occup Environ Med 2019 61 (12) e510-e515 OBJECTIVE: To establish the burden of totally disabling respiratory impairment among coal miners, we identified the healthcare utilization and cost for Medicare claims where the Federal Black Lung Program (FBLP) was the primary payer. METHODS: We extracted FBLP claims from 1999-2016 institutional Medicare data along with beneficiary, comorbidity, and claim cost information. Healthcare utilization was evaluated and compared to the 2016 Medicare population. RESULTS: The FBLP was the primary payer on 75,690 claims from 19,700 beneficiaries and paid an increasing percentage of the total paid to providers annually. Claims decreased from 1999-2016 but cost per claim increased. Beneficiaries were hospitalized and visited the ER for respiratory and cardiovascular conditions. CONCLUSIONS: Medicare beneficiaries with FBLP primary payer claims have higher healthcare utilization and comorbidities compared to Medicare enrollees, indicative of increased financial and healthcare burden. |
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. |
Respirable coal mine dust in underground mines, United States, 1982-2017
Doney BC , Blackley D , Hale JM , Halldin C , Kurth L , Syamlal G , Laney AS . Am J Ind Med 2019 62 (6) 478-485 BACKGROUND: This study summarized the mass concentration and quartz mass percent of respirable coal mine dust samples (annually, by district, and by occupation) from underground coal mines during 1982-2017. METHODS: Respirable dust and quartz data collected and analyzed by Mine Safety and Health Administration (MSHA) were summarized by year, coal mining occupation, and geographical area. The older (before August 2016) 2.0 mg/m (3) respirable dust MSHA permissible exposure limit (PEL) was used across all years for comparative purposes. For respirable dust and quartz, geometric mean and percent of samples exceeding the respirable dust PEL (2.0 mg/m (3) or a reduced standard for samples with >5% quartz content) were calculated. For quartz samples, the average percent quartz content was also calculated. RESULTS: The overall geometric mean concentration for 681 497 respirable dust samples was 0.55 mg/m (3) and 5.5% of the samples exceeded the 2.0 mg/m (3) PEL. The overall respirable quartz geometric mean concentration for 210 944 samples was 0.038 mg/m (3) and 18.7% of these samples exceeded the applicable standard. There was a decline over time in the percent of respirable dust samples exceeding 2.0 mg/m (3) . The respirable dust geometric mean concentration was lower in central Appalachia compared to the rest of the United States. However, the respirable quartz geometric mean concentration and the mean percent quartz content were higher in central Appalachia. CONCLUSION: This study summarizes respirable dust and quartz concentrations from coal mine inspector samples and may provide an insight into differences in the prevalence of pneumoconiosis by region and occupation. |
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. |
Occupational exposure and airflow obstruction and self-reported COPD among ever-employed US adults using a COPD-job exposure matrix
Doney B , Kurth L , Halldin C , Hale J , Frenk SM . Am J Ind Med 2019 62 (5) 393-403 INTRODUCTION: This study examined the association of spirometry-defined airflow obstruction and self-reported COPD defined as self-reported doctor diagnosed chronic bronchitis or emphysema, with occupational exposure among ever-employed US adults. METHODS: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007-2008 to 2011-2012, a nationally representative study of the non-institutionalized civilian US population. Reported current and/or longest held job were used to create prevalence estimates and prevalence odds ratios (PORs) (adjusted for age, gender, race, and smoking status) for airflow obstruction and self-reported COPD by occupational exposure, determined using both NHANES participants' self-reported exposures and eight categories of COPD job exposure matrix (JEM) assigned exposures. RESULTS: Significant PORs for airflow obstruction and self-reported COPD respectively were observed with self-reported exposure for >/=20 years to mineral dust (POR = 1.44; 95% confidence interval (CI) 1.13-1.85; POR = 1.69; 95% CI 1.17-2.43) and exhaust fumes (POR = 1.65; 95% CI 1.27-2.15; POR = 2.22; 95% CI 1.37-3.58). Airflow obstruction or self-reported COPD were also associated with COPD-JEM assigned high exposure to mineral dust, combined dust, diesel exhaust, vapor-gas, sensitizers, and overall exposure. CONCLUSION: Airflow obstruction and self-reported COPD are associated with both self-reported and JEM-assigned exposures. |
Airflow obstruction among ever-employed U.S. adults aged 18-79 years by industry and occupation: NHANES 2007-2008 to 2011-2012
Kurth L , Doney B , Halldin C , Hale J , Frenk SM . Am J Ind Med 2018 62 (1) 30-42 INTRODUCTION: This study estimated the prevalence of spirometry-defined airflow obstruction by industry and occupation and chronic obstructive pulmonary disease (COPD) among ever-employed U.S. adults. METHODS: Data came from the National Health and Nutrition Examination Survey (NHANES) 2007-2008 to 2011-2012, a nationally representative study of the non-institutionalized civilian U.S. POPULATION: Data on respondent's current and/or longest held job were used to create prevalence estimates and adjusted prevalence odds ratios (PORs) for airflow obstruction and COPD. RESULTS: Among ever-employed U.S. adults, airflow obstruction prevalence was 12.40% and COPD was 3.47%. High airflow obstruction prevalence and significant PORs were reported in mining; manufacturing; construction; and services to buildings industries as well as extraction; bookbinders, prepress, and printing; installers and repairers; and construction occupations. CONCLUSION: Prevalence of airflow obstruction varies by industry and occupation. Industries and occupations with increased risk were identified using the most current NHANES data including detailed occupations and spirometry. |
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. |
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