Federal researchers have documented a significant resurgence in black lung disease among underground coal miners in central Appalachia, with prevalence rates returning to levels not seen since 1978. According to a peer-reviewed research letter published in the American Journal of Respiratory and Critical Care Medicine by the National Institute for Occupational Safety and Health (NIOSH), approximately 32.5% of miners with at least 25 years of underground work experience tested positive for coal workers’ pneumoconiosis in screenings conducted over the past five years. This represents a sharp increase from the 20.6% rate documented in 2018 and marks a reversal of decades of improvement that followed strict federal regulations imposed in the mid-1970s.
The disease progression has accelerated in recent years, with younger miners showing signs of the advanced stage of black lung at unprecedented rates. Clinicians and researchers attribute this trend to changes in mining practices, particularly the shift toward extracting thinner coal seams that require cutting through large amounts of rock. Much of this rock in Appalachia contains quartz, exposing miners to high levels of crystalline silica dust, which is significantly more toxic than coal dust alone. Data analysis reveals thousands of instances of excessive silica dust exposure in coal mines since 2014, creating what experts describe as repeated opportunities for workers to develop the disease.
Despite improvements in compliance with federal dust exposure limits—with mining companies meeting current standards more than 90% of the time in recent years—the disease burden continues to mount. Mortality data shows more than 1,700 coal miners died from black lung between 2020 and 2023. Black lung clinics across Appalachia report diagnosing thousands of new cases, with some facilities identifying over 2,400 cases in the past five years alone. The financial impact extends beyond affected workers, with the federal black lung trust fund disbursing over $175 million in 2024 to miners and their dependents.
Efforts to strengthen protections have faced legal and political obstacles. Although the Biden administration established a new silica dust regulation in 2024 with twice as restrictive exposure limits, federal courts have indefinitely delayed enforcement following industry lawsuits. The Trump administration has announced it will also hold enforcement in abeyance while supporting expanded coal production and power generation. Mining companies have advocated for increased reliance on respirators rather than engineering controls, an approach that conflicts with federal law requiring coal mine operators to maintain conditions sufficiently free of dust to allow workers to pursue entire careers without developing black lung disease.
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