标题：Potential Determinants of Coal Workers’ Pneumoconiosis, Advanced Pneumoconiosis, and Progressive Massive Fibrosis Among Underground Coal Miners in the United States, 2005–2009
摘要：Objectives. We better defined the distribution and determinants of coal workers’ pneumoconiosis (CWP) among US underground coal miners. Methods. We obtained chest radiographs from the mobile unit of an enhanced surveillance program begun in 2005 by the National Institute for Occupational Safety and Health for underground coal miners. B Readers classified them for presence of pneumoconiosis. Results. Miners from 15 states participated (n = 6658). The prevalence of CWP was higher in 3 states (Kentucky, 9.0%; Virginia, 8.0%; West Virginia, 4.8%) than in 12 other states (age-adjusted risk ratio [RR] = 4.5; 95% confidence interval [CI] = 3.3, 6.1). Miners in these 3 states were younger and had less mining tenure, but advanced CWP (category ≥ 2/1; RR = 8.1; 95% CI = 3.9, 16.9) and progressive massive fibrosis (RR = 10.5; 95% CI = 3.8, 29.1) was more prevalent among them. Advanced CWP and progressive massive fibrosis were more prevalent among workers at mines with fewer than 155 miners, irrespective of mining region, than among workers at larger mines. Conclusions. Enhanced surveillance results confirmed the persistence of severe CWP among US coal miners and documented the health consequences of inadequate dust control for miners in parts of Appalachia and at smaller mines. In the early 2000s, during the routine analysis of surveillance chest radiographs of underground coal miners, the National Institute for Occupational Safety and Health (NIOSH) began observing several aberrations in the frequency and severity of radiographic abnormalities among underground coal miners in the United States. Specifically, the overall prevalence of coal workers’ pneumoconiosis (CWP) appeared to be increasing, and NIOSH identified geographical clustering of CWP and observed rapid progression and increased disease severity, including progression to the most severe and fatal stage, progressive massive fibrosis (PMF). 1,2 In response to these occupational health findings, NIOSH, with support from the US Department of Labor’s Mine Safety and Health Administration, established and implemented the Enhanced Coal Workers’ Health Surveillance Program (ECWHSP). ECWHSP, using a mobile examination unit in areas in which rapidly progressing CWP had been identified, 1–4 further assessed the initial surveillance findings, better defined the scope and magnitude of the problem and identified potentially remediable causes of the continuing development and progression of lung disease among underground coal miners. Our focus was ECWHSP’s radiographic findings consistent with CWP among miner participants. Specifically, we examined the radiographic patterns among this group of at-risk miners and investigated potential explanatory factors such as mine location and size.
