Radiographic outcomes among South African coal miners

Objectives: This study, the first to document the prevalence of pneumoconiosis among a living South African coal mining cohort, describes dose–response relationships between coal workers’ pneumoconiosis and respirable dust exposure, and relationships between pneumoconiosis and both lung function deterioration and respiratory symptoms. Methods: A total of 684 current miners and 188 ex-miners from three bituminous-coal mines in Mpumalanga, South Africa, was studied. Chest radiographs were read according to the International Labour Organization (ILO) classification by two experienced readers, one an accredited National Institute for Occupational Safety and Health (NIOSH) “B” reader. Interviews were conducted to assess symptoms, work histories (also obtained from company records), smoking, and other risk factors. Spirometry was performed by trained technicians. Cumulative respirable dust exposure (CDE) estimates were constructed from historical company-collected sampling and researcher-collected personal dust measurements. κ-Statistics compared the radiographic outcomes predicted by the two readers. An average profusion score was used in the analysis for the outcomes of interest. Because of possible confounding by employment status, most analyses were stratified on current and ex-miner status. Results: The overall prevalence of pneumoconiosis was low (2%–4%). The degree of agreement between the two readers for profusion was moderate to high (κ=0.58). A significant association (P<0.001) and trend (P<0.001) was seen for pneumoconiosis with increasing categories of CDE among current miners only. A significant (P<0.0001) additional 58 mg-years/m³ CDE was seen among those with pneumoconiosis compared to those without. CDE contributed to a statistically significant 0.19% and 0.11% greater decline in the percent predicted 1-second forced expiration volume (FEV₁) and forced vital capacity (FVC), respectively, among current miners with pneumoconiosis than among those without. Logistic regression models showed no significant relationships between pneumoconiosis and symptoms. Conclusions: The overall prevalence of pneumoconiosis, although significantly associated with CDE, was low. The presence of pneumoconiosis is associated with meaningful health effects, including deterioration in lung function. Intervention measures that control exposure are indicated, to reduce these functional effects.