Estimating the prevalence and spatial clusters of coal workers' pneumoconiosis cases using medicare claims data, 2011‐2014

Abstract

BackgroundWorkers employed in the coal mining sector are at increased risk of respiratory diseases, including coal workers' pneumoconiosis (CWP). We investigated the prevalence of CWP and its association with sociodemographic factors among Medicare beneficiaries.MethodsWe used 5% Medicare Limited Data Set claims data from 2011 to 2014 to select Medicare beneficiaries with a diagnosis of ICD‐9‐CM 500 (CWP). We aggregated the data by county and limited our analysis to seven contiguous states: Illinois, Indiana, Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia. We estimated county‐level prevalence rates using total Medicare beneficiaries and miners as denominators and performed spatial hotspot analysis. We used negative binomial regression analysis to determine the association of county‐wise sociodemographic factors with CWP.ResultsThere was significant spatial clustering of CWP cases in Kentucky, Virginia, and West Virginia. Spatial clusters of 210 and 605 CWP cases representing an estimated 4200 to 12 100 cases of Medicare beneficiaries with CWP were identified in the three states. Counties with higher poverty levels had a significantly elevated rate of CWP (adjusted rate ratios [RR]: 1.15; 95% CI, 1.12‐1.18). There was a small but significant association of CWP with the county‐wise catchment area. Rurality was associated with a more than three‐fold elevated rate of CWP in the unadjusted analysis (RR: 3.28, 95% CI, 2.22‐4.84). However, the rate declined to 1.45 (95% CI, 1.04‐2.01) after adjusting for other factors in the analysis.ConclusionsWe found evidence of significant spatial clustering of CWP among Medicare beneficiaries living in the seven states of the USA.

Mortality among workers employed in the mining industry in the United States: A 29‐year analysis of the National Health Interview Survey—Linked Mortality File, 1986‐2014

“…Despite the decline in both fatal and nonfatal injuries, the resurgence of morbidity and mortality from chronic silica exposure 22 and coal workers' pneumoconiosis (CWP) 23 in the mining industry, requires continued occupational health awareness, policy enforcement, and monitoring. We recently reported an increased prevalence of chronic diseases, including CWP among exminers in the United States 24,25 …”

A systematic review and meta-analysis on international studies of prevalence, mortality and survival due to coal mine dust lung disease

“…Several studies based on national surveillance data of the current coal miner workforce in the USA reported estimates of 2.1–5.1% [ 19 , 25 , 31 , 32 , 34 , 35 , 37 – 39 ] although they varied in their time periods and duration (years). Two other studies used compensation data to report widely varying estimates of 0.2% among Medicare beneficiaries [ 20 ] and 33.8% among miners who applied for benefits through the federal black lung benefits program [ 7 ], probably reflecting differences in data collection methods.…”

“…Excluded studies typically did not report overall estimates (n = 7) [ 22 , 23 , 26 , 27 , 31 , 33 , 37 ], or did not present sufficient information to be included (n = 3) [ 40 , 53 , 54 ]. Three studies based on compensation databases [ 7 , 15 , 20 ] were also dropped as denominator was not comparable to surveillance-based studies. In addition, the single study from the UK [ 50 ] and one study each that reported estimates for only COPD [ 55 ] or silicosis [ 24 ] were excluded.…”

Estimating mortality from coal workers' pneumoconiosis among Medicare beneficiaries with pneumoconiosis using binary regressions for spatially sparse data

“…Conventionally, epidemiological‐based estimates of mortality have rightfully relied on nonparametric approaches. While this methodological approach provides suitable risk estimates, CWP is primarily an occupational disease, 18 exhibiting spatial characteristics 9 . Spatial and small area estimators 19 are, therefore, appropriate elements in modeling the mortality risk of CWP.…”

“…4 Additionally, recent studies have identified clusters and hotspots of CWP in Kentucky, Virginia, West Virginia, and Central Appalachia. 4,5,9 Studies have demonstrated an increased risk of mortality from CWP among coal miners. [10][11][12] Underground miners with CWP in the Czech Republic have a 10% excess mortality than underground miners without CWP.…”