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Cosmos Study

No Surge in Silicosis

November 3, 2023
Dual-Team Study
Team A:Kersten Bartelt, RNEric Barkley
Team B:Sam Butler, MDBrendan JoyceJoe Longo

Key Findings

  • The rate of silicosis diagnoses per year has declined, from eight per million patients in 2017 to six per million in 2023. 
  • New silicosis diagnosis rates between January 2017 and July 2023 were highest in West Virginia, New Mexico, and Nevada, at 154.5, 150.9, and 90.9 per million patients, respectively. 
  • The most common demographics diagnosed with silicosis between January 2017 and July 2023 were males (44.5 per million) and those living in rural areas (49.1 per million). 

Silicosis is a respiratory condition that is typically caused by inhaling fine silica particles in industries like construction, mining, manufacturing, and stone countertop finishing and installation.1 Because the condition often results in permanent lung damage and can be disabling, the Occupational Safety and Health Administration (OSHA) has required employers to take steps to mitigate potential risks for silicosis since 1970.2 It has recently been reported that silicosis is on the rise in the countertop industry in California.3  

In response, we examined whether there has been a year-over-year change in silicosis diagnoses throughout the United States. We evaluated 129 million patients, of whom 3,014 were newly diagnosed with silicosis, between January 1, 2017, and July 31, 2023, for trends in diagnosis rates over time. In 2017, patients were newly diagnosed with silicosis at a rate of 8 per million patients. That rate fluctuated slightly over the following years and is 6 per million in 2023.  

Figure 1
Annual Silicosis Diagnoses per Million Patients
Annual Silicosis Diagnoses per Million Patients
Figure 1. The annual rate of new silicosis diagnoses per million patients.

We further evaluated the diagnosis rate across states to identify which states had the highest rates of diagnosis. Because of the infrequency of silicosis, trends over time could not be evaluated at the state level. The national rate for new silicosis diagnoses for the entire study period—January 2017 through July 2023—was 23.5 per million patients. At the state level, West Virginia had the highest rates in our study period (154.5 per million patients), followed by New Mexico (150.9 per million), and Nevada (90.9 per million). The states with the lowest rates were Tennessee (7.7 per million), Hawaii (7.7 per million), and California (9.4 per million). 

Figure 2
Silicosis Diagnoses per Million Patients by State
Silicosis Diagnoses per Million Patients by State
Figure 2. The rate of new silicosis diagnoses per million by state between January 1, 2017, and July 31, 2023.

Finally, we stratified the diagnosis rates by patient sex, race, ethnicity, and social vulnerability index (SVI) quartile during our study period. We found that males were 6.5 times more likely to be diagnosed with silicosis than females. When evaluating by race and ethnicity, we found that non-Hispanic White patients were 41% more likely than Black patients and 34% more likely than Hispanic patients to be diagnosed. Patients living in rural areas were more than twice as likely to be diagnosed with silicosis than those living in an urban area. Additionally, those in the most vulnerable SVI quartiles were most likely to be diagnosed with silicosis compared to the least vulnerable quartiles.  

Figure 3
Diagnosis Rate of Silicosis by Patient Demographic
Diagnosis Rate of Silicosis by Patient Demographic
Figure 3. The rate of new silicosis diagnoses per million patients by demographics between January 1, 2017, and July 31, 2023.

These data come from Cosmos, a collaboration of 222 Epic health systems representing over 220 million patient records from 1,272 hospitals and more than 27,200 clinics from all 50 states and Lebanon. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.   

  1. Silicosis. (n.d.). American Lung Association. https://www.lung.org/lung-health-diseases/lung-disease-lookup/silicosis. Accessed October 26, 2023. 
  2. Worker Exposure to Silica during Countertop Manufacturing, Finishing and Installation. (n.d.). Occupational Safety and Health Administration. Worker Exposure to Silica during Countertop Manufacturing, Finishing and Installation (osha.gov). Accessed September 20, 2023. 
  3. Greenfieldboyce, N. (2023, July 24). Young men making quartz countertops are facing lung damage. One state is taking action. NPR. https://www.npr.org/sections/health-shots/2023/07/24/1189745247/silicosis-young-workers-kitchen-countertops-lung-damage-california