Black lung cases surge to 1970s levels as dust protections stall in Appalachia

A new NIOSH study shows that veteran underground miners in central Appalachia now have the highest black-lung rates in almost five decades, while regulatory enforcement remains delayed.

A peer-reviewed NIOSH research letter reveals that one-third of veteran underground coal miners in Kentucky, Virginia and West Virginia with at least 25 years of service now show black-lung disease on X-rays, the highest prevalence since 1978. Even miners with as few as 15 years underground exhibit rates unseen for nearly 40 years, a trend tied to the shift toward thinner seams that generate silica-rich dust. While the National Mining Association claims current dust levels are within modern limits, analysis of Mine Safety and Health Administration data shows more than 5,000 instances of excessive silica exposure since 2014.

A 2024 rule tightening silica limits has been stalled by industry lawsuits and a lack of enforcement under the current administration. The surge adds pressure to a federal trust fund that paid $175 million to miners and families in 2024 and raises concerns about future lung-transplant costs. Advocates, including pulmonologists and former regulators, call the situation an “outrageous” public-health failure that demands immediate action.