Uncovering the Factors Behind Rising Pneumoconiosis Rates: Central Appalachian Underground Coal Miners as a Case Study.

This review examines key factors, both established and lesser known, driving the resurgence of pneumoconiosis in central Appalachia, the region with the highest disease incidence in the United States. It synthesizes findings from peer-reviewed literature and grey sources, including government reports, focusing on underground coal miners in the region. Four key factors are identified: historical economic trends, geologic conditions, technological changes, and health monitoring participation. The shrinking mining workforce has reduced operational size but increased productivity, raising individual exposure to respirable dust. Extensive mining has depleted accessible coal, forcing operators to mine adjacent rock layers, which increases exposure to toxic silica in dust. To maintain production, risky practices such as slope mining, new cleaning techniques, and powerful mining machines are being adopted, generating higher dust concentrations and smaller particulates, further exacerbating exposure. The presence of quartz-bearing formations also contributes to hazardous conditions. Finally, low participation in health screening programs disrupts disease detection and protective efforts.