Coal miners in central Appalachia are contracting black lung disease at rates not seen in nearly 50 years, according to new research from the National Institute for Occupational Safety and Health published in August 2026. The resurgence, driven largely by toxic silica dust rather than coal dust alone, comes as new federal protections have been stuck in legal limbo, with mining companies suing to block enforcement and the Trump administration declining to defend the rules. Researchers and doctors describe the findings as a damning indictment of decades of regulatory failure, with one NIOSH scientist saying miners "are being treated like disposable widgets, not human beings."

Among veteran underground miners with 25 or more years' experience in Kentucky, Virginia and West Virginia, 32.5% tested positive for the disease over the past five years, matching levels last seen in 1978 and up sharply from 20.6% in 2018. More than 1,700 miners died from black lung between 2020 and 2023, and over 4,000 have been diagnosed with advanced disease since 2010. The problem stems from mining thinner coal seams that require cutting through more silica-laden rock, producing dust up to 20 times more toxic than coal dust alone; stricter Biden-era silica limits introduced in 2024 have been delayed indefinitely by court challenges from the industry, even as the federal black lung trust fund—already $3bn in debt—continues paying out hundreds of millions annually to affected miners.