Patterns of pneumoconiosis mortality in Kentucky: Analysis of death certificate data.

BACKGROUND Mortality rates associated with total pneumoconiosis, including coal worker's pneumoconiosis (CWP), have remained elevated. METHODS 2003-2013 pneumoconiosis mortality data obtained from National Center for Health Statistics and 2011-2013 Kentucky death certificates were analyzed. RESULTS Total pneumoconiosis mortality rates showed significant linear decreases in West Virginia, Pennsylvania, Kentucky, and the U.S. from 2003 to 2013; Pennsylvania and Kentucky had comparable rates in 2003 but while Pennsylvania rates significantly decreased ∼3.0 deaths/million annually, Kentucky rates decreased only 0.5/million annually. Kentucky and Pennsylvania CWP fatality rates were also comparable in 2003 but while Pennsylvania rates decreased 82% over the study period, Kentucky rates decreased only 26%. Kentucky pneumoconiosis deaths primarily occurred in white Appalachian males in-hospital. Diseases leading to pneumoconiosis death were largely respiratory and cardiovascular, with autopsies rarely performed. CONCLUSIONS Coal worker environmental exposure protection should be enhanced and pneumoconiosis surveillance improvements, including enhanced management of comorbid conditions like COPD, should be considered.