Earlier this year, the Journal of the American Medical Association published a study from the National Institute for Occupational Safety and Health, which found 416 cases of advanced black lung disease in coal miners in central Appalachia from 2013 to 2017 — the highest cluster of cases ever seen. The institute also confirmed a 2016-2017 investigation by National Public Radio (NPR) that discovered hundreds of other cases in southwestern Virginia, southern West Virginia and eastern Kentucky.

This research indicates that black lung is returning, even as safety measures have improved over the course of decades. Dust screens and ventilation had nearly removed the disease from the U.S. in the 1990s, but these recent studies suggest otherwise in coal country.