Occupational History of Coal Mining and its Association with Restrictive and Obstructive Lung Disease Among Males in Two Counties in Rural Appalachian Kentucky Open Access
McKenna, Caileigh (Summer 2022)
Abstract
Objective. Appalachian (Eastern) Kentucky has a high burden of lung disease, partially attributable to significant occupational exposure to coal mine dust in the 7th largest coal producing state in the United States. Cases of coal workers’ pneumoconiosis and its most severe form, pulmonary massive fibrosis, began increasing significantly in Central Appalachia, and Appalachian Kentucky in particular, around 2000. There is a need to better understand the association between coal mine dust lung disease and coal mining exposure in Eastern Kentucky to better guide prevention efforts and operating practices.
Methods. The analysis utilized cross-sectional data from the University of Kentucky, obtained in Harlan and Letcher counties between 2015 and 2017. Multivariable Poisson regression with robust standard errors was performed to assess the association between lung disease, defined by spirometric pattern as obstructive, restrictive, or normal, and coal mining history, defined as never, underground only, surface only, and both types, adjusted for age, education, smoking level, and history of other dusty jobs. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were obtained. The adjusted analyses were further stratified by age and coal mining tenure.
Results. The aPR for the association between obstructive lung disease and a history of underground coal mining, surface coal mining, and underground and surface coal mining were 1.45 (95% CI: 0.94-2.25), 1.20 (95% CI: 0.71-2.02), and 1.51 (95% CI: 0.96-2.38), respectively. The aPR for the association between restrictive lung disease and a history of underground coal mining, surface coal mining, and underground and surface coal mining were 1.18 (95% CI: 0.74-1.90), 0.997 (95% CI: 0.71-2.02), and 1.51 (95% CI: 0.96-2.38), respectively.
Conclusions. The observed effects for this study demonstrated much stronger associations for obstructive lung disease compared to restrictive lung disease and for underground coal mining and both types of coal mining compared to surface coal mining. Generally, the effects of the association for the older age group and longer coal mining tenure group were stronger than the younger age group and shorter mining tenure group, respectively. The analyses were limited by a lack of statistical power and potential survival bias.
Table of Contents
CHAPTER 1: LITERATURE REVIEW 1
Public Health Significance 2
Coal mining 4
The history of coal production in the United States 4
Coal mining by region 5
Coal mining in Kentucky 6
Coal mining methods 6
Coal rank 7
Pulmonary function and spirometry 7
Spirometry 7
Spirometry interpretation 8
Obstructive pattern of pulmonary function impairment 8
Restrictive pattern of pulmonary function impairment 9
Spirometry pattern in coal mine dust lung disease (CMDLD) 9
Coal mine dust lung disease (CMDLD) 10
Introduction to CMDLD 10
CMDLD prevention and industry regulation 10
Restrictive coal mine dust lung diseases 12
Introduction 12
Radiographic classification of pneumoconioses 12
Coal workers’ pneumoconiosis (CWP) 13
Coal mine dust composition 14
CWP Pathophysiology 14
Clinical presentation 15
Silicosis 15
Mixed-dust pneumoconiosis (MDP) 16
Dust-related diffuse fibrosis (DDF) 16
Obstructive coal mine dust lung disease 17
Introduction 17
Chronic obstructive pulmonary disease (COPD) 17
Chronic bronchitis 17
Emphysema 18
Clinical features 18
COPD and coal mining 18
Coal workers’ pneumoconiosis epidemiology and trends 19
Risk factors for Coal Mine Dust Lung Disease 23
Study rationale 24
CHAPTER 2: MANUSCRIPT 26
Abstract 27
Objective 27
Methods 27
Results 27
Conclusions 27
Introduction 28
Methods 32
Study design and sample 32
Outcome variable 35
Exposure variable 36
Covariates 37
Statistical analysis 39
Results 41
Descriptive statistics 41
Multivariable adjusted model 43
Multivariable adjusted model stratified by age 43
Multivariable adjusted model stratified by coal mining tenure 44
Discussion 45
Tables and Figure 50
Figure 1 50
Table 1 51
Table 2 54
Table 3 54
Table 4 55
Table 5 55
Table 6 56
Table 7 56
Table 8 57
CHAPTER 3: FUTURE DIRECTIONS/PUBLIC HEALTH IMPLICATIONS 58
Recommendations 59
Future research 59
Policy 59
REFERENCES 60
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