Black lung disease rates among veteran underground coal miners in central Appalachia have risen to levels not seen since the late 1970s, according to new data from researchers at the National Institute for Occupational Safety and Health (NIOSH) reported by NPR, Public Health Watch and Kentucky Public Radio.

According to the data, one in three working miners in Kentucky, Virginia and West Virginia with at least 25 years of experience tested positive for the incurable disease in X-rays conducted by NIOSH during the last five years: a significant increase from previous reporting.

Experts say there’s a strong link between black lung disease and silica dust — which is sometimes encountered at dangerous levels in mining and is around 20 times more toxic than coal dust alone. While a tougher federal silica regulation was imposed in 2024, legal challenges from the mining industry have indefinitely delayed enforcement. As thousands of miners suffer from the disease, advocates warn that enforcement of stricter safety protections is needed to help stem the ongoing human toll in coal country.

In light of this new reporting, we are re-releasing our 2019 podcast episode “Struggling for Breath in Coal Country,” in which correspondent Howard Berkes spoke with coal miners whose lives were forever changed when they were diagnosed with black lung. Now updated with a new introduction, this episode of The FRONTLINE Dispatch was originally released alongside FRONTLINE and NPR’s documentary, Coal’s Deadly Dust, which is available streaming on FRONTLINE’s website or our YouTube channel.