Association between Financial Conflicts of Interest and International Labor Office Classifications for Black Lung Disease.

Rationale: The U.S. Department of Labor administers the Federal Black Lung Program (FBLP), an administrative system charged with managing claims by coal miners for workers' compensation for totally disabling coal mine dust lung disease. Specific case reports have raised concern that financial conflicts of interest (COIs) may systematically bias physicians when they are classifying chest X-rays (CXRs) for the absence, presence, and severity of pneumoconiosis. Objectives: To evaluate the direction and magnitude of association between financial COIs of physicians participating in the FBLP and international standards for the classification of radiographs of pneumoconiosis. Methods: An epidemiologic assessment of black lung claims filed to the FBLP from 2000 to 2013 was conducted to determine physician classifications of radiographs. FBLP court decisions from 2002 to 2019 (n = 7,656) were used to evaluate financial COIs of each physician. The main outcome measures used were classifications of radiographs for the absence of pneumoconiosis (small opacity classifications of 0/0 or 0/1), simple pneumoconiosis (small opacity classifications of 1/0 through 3/+), and progressive massive fibrosis (PMF) (large opacities with classifications of A, B, or C). Results: Of 63,780 radiograph classifications made by 264 physicians, 31.4% were read positive for simple pneumoconiosis and 3.6% were read as having PMF. There were 52 physicians who classified CXRs as having no evidence of pneumoconiosis in 99%+ of their readings and 18 physicians who classified CXRs as positive for simple pneumoconiosis in 99%+ of their readings. The adjusted odds of a negative classification of pneumoconiosis was 1.46 (95% confidence interval [CI], 1.44-1.47) per 10% increase in the proportion of court records demonstrating that a physician was hired by the employer. Per 10% increase in court records indicating a physician was hired by the miner/claimant, the adjusted odds ratio for classifying simple pneumoconiosis was 1.51 (95% CI, 1.49-1.52), and the adjusted odds ratio for finding PMF was 1.28 (95% CI, 1.26-1.30). Conclusions: There was a strong association between source of payment and radiograph classification, suggesting the importance of eliminating financial COIs in what should be an objective determination of eligibility for Black Lung Workers' compensation benefits.

Injuries during the first hour at work in the U.S. mining industry.

BACKGROUND: The first hour of a shift in a mine is characterized by a large movement of miners from incoming and outgoing shifts, in addition to safety and maintenance checks of mining equipment. These activities rely on communication to ensure a safe transition between shifts. This study aims to identify risk factors for injury among miners during the first hour of a work shift and to characterize injury outcomes. METHODS: Data from U.S. Mine Safety and Health Administration Part 50 reports, 1983-2015, were used to identify injuries occurring within the first hour of a shift. Multivariable logistic regression was used to evaluate predictors of injuries occurring during the first shift-hour and to assess the outcome of these injuries. RESULTS: Out of the 545,537 cases included in the analysis, 16,446 injuries occurred during the first hour of a shift. Risk factors associated with these injuries included being female, being older, working on Sunday and Monday, having an irregular shift start, working night shifts, employed in surface mining operations, and mine operations with <200 employees, and mechanisms of injury related to falls, movement of equipment and personnel, and being struck by or caught between boxes and containers. Injurious incidents occurring during the first hour of work were associated with mass injury events involving five or more workers (aOR = 3.58; 95% CI: 2.77, 4.64). CONCLUSIONS: Although injury rates were substantially lower during the first hour of work compared to all other work hours, this study identified risk factors and mechanisms of injury that are highly preventable during the first hour of work.