Racial Differences in Respiratory Impairment, Pneumoconiosis, and Federal Compensation for Western U.S. Indigenous Coal Miners.

Indigenous coal miners experience greater adjusted odds for pneumoconiosis and respiratory impairment per decade of life, and greater decline in FEV1 despite lower smoking rates. Structural inequities exist in federal spirometry requirements for Indigenous miners seeking DOL Black Lung benefits. Regulatory reform is needed to address barriers to compensation for these underrepresented workers.