The National Institute for Occupational Safety and Health B Reader Certification Program-An Update Report (1987 to 2018) and Future Directions.

OBJECTIVE: The National Institute for Occupational Safety and Health (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 to 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-1990s, the number of B Readers has declined and the mean age and years certified have 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.

Evaluation of high blood pressure and obesity among US coal miners participating in the Enhanced Coal Workers' Health Surveillance Program.

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.

Comparative Respiratory Morbidity of Former and Current US Coal Miners.

We compared the prevalence of respiratory disease in former and current US coal miners using chest radiographs and lung functions collected from 2009 to 2013 among miners of the Appalachian and Interior US coalfields. We calculated prevalence ratios (PRs) of pneumoconiosis and impaired lung function. Significantly higher prevalences of pneumoconiosis (PR = 1.5; 95% confidence interval = 1.2, 2.0) and impaired lung function were observed among former miners compared with active miners. Former miners continue to suffer negative health effects from occupational coal mine dust exposure. The respiratory health of active and former miners is a global concern because international coal production is projected to increase for decades to come.

Debilitating lung disease among surface coal miners with no underground mining tenure.

OBJECTIVE: To characterize exposure histories and respiratory disease among surface coal miners identified with progressive massive fibrosis from a 2010 to 2011 pneumoconiosis survey. METHODS: Job history, tenure, and radiograph interpretations were verified. Previous radiographs were reviewed when available. Telephone follow-up sought additional work and medical history information. RESULTS: Among eight miners who worked as drill operators or blasters for most of their tenure (median, 35.5 years), two reported poor dust control practices, working in visible dust clouds as recently as 2012. Chest radiographs progressed to progressive massive fibrosis in as few as 11 years. One miner's lung biopsy demonstrated fibrosis and interstitial accumulation of macrophages containing abundant silica, aluminum silicate, and titanium dust particles. CONCLUSIONS: Overexposure to respirable silica resulted in progressive massive fibrosis among current surface coal miners with no underground mining tenure. Inadequate dust control during drilling/blasting is likely an important etiologic factor.

Lung-function impairment among US underground coal miners, 2005 to 2009: geographic patterns and association with coal workers' pneumoconiosis.

OBJECTIVE: To investigate contemporary geographic distributions of lung-function impairment and radiographic evidence of coal workers' pneumoconiosis (CWP) and their associations. METHODS: From 2005 to 2009, 6373 underground coal miners completed a health survey, including spirometry testing and chest radiography. Coal workers' pneumoconiosis and progressive massive fibrosis were determined by NIOSH B readers, using the International Labour Office classification. Prevalences of CWP and spirometry less than lower normal limits were mapped by county, and their association assessed. RESULTS: The prevalences of abnormal spirometry results and CWP were 13.1% and 4.0%, respectively. Counties with elevated prevalences for both the outcomes were located in contiguous areas of southeastern Kentucky, western Virginia, southern West Virginia, and eastern Pennsylvania. Prevalence of abnormal spirometry results increases with increasing category of simple CWP and progressive massive fibrosis. CONCLUSIONS: Abnormal spirometry in coal miners is associated with CWP; these two health outcomes have similar geographic distributions.

Potential determinants of coal workers' pneumoconiosis, advanced pneumoconiosis, and progressive massive fibrosis among underground coal miners in the United States, 2005-2009.

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.

Conversion to use of digital chest images for surveillance of coal workers' pneumoconiosis (black lung).

To protect the health of active U.S. underground coal miners, the National Institute for Occupational Safety and Health (NIOSH) has a mandate to carry out surveillance for coal workers' pneumoconiosis, commonly known as Black Lung (PHS 2001). This is accomplished by reviewing chest x-ray films obtained from miners at approximately 5-year intervals in approved x-ray acquisition facilities around the country. Currently, digital chest images are not accepted. Because most chest x-rays are now obtained in digital format, NIOSH is redesigning the surveillance program to accept and manage digital x-rays. This paper highlights the functional and security requirements for a digital image management system for a surveillance program. It also identifies the operational differences between a digital imaging surveillance network and a clinical Picture Archiving Communication Systems (PACS) or teleradiology system.