# A population-based retrospective cohort study of 4,103 pneumoconiosis cases in Zhenjiang, China, 1965–2025: a survival analysis

## TL;DR

This study analyzes survival rates of 4,103 pneumoconiosis patients in China to identify risk factors and suggest interventions for better health outcomes.

## Contribution

The study identifies key risk factors for mortality in pneumoconiosis patients and proposes targeted public health interventions.

## Key findings

- Stage III diagnosis at onset significantly increases mortality risk in pneumoconiosis patients.
- Mining and manufacturing industries, along with medium-sized enterprises, are linked to higher mortality rates.
- Early-onset pneumoconiosis and delayed disease progression are critical for improving survival.

## Abstract

To identify key determinants of survival outcomes in pneumoconiosis patients, quantify their associations with mortality risk, and develop evidence-based intervention strategies for improving quality of life in this population, grounded in epidemiological findings.

Life-table analysis was employed to calculate survival probabilities and mortality density during the observation period. Kaplan–Meier methods were used to generate survival curves with intergroup comparisons performed by log-rank tests. Cox proportional hazards regression models were applied to evaluate the independent effects of covariates on survival time.

A total of 4,103 cases had several species of pneumoconiosis, including silicosis, coal worker pneumoconiosis, welder pneumoconiosis, and other pneumoconiosis that accounted for 65.56, 28.22, 1.54 and 4.68% of total pneumoconiosis, respectively. 77.82% of cases were initially diagnosed at Stage I, 18.94% at Stage II, and 3.24% at Stage III. 85.86% of patients remained stable condition, 14.14% upgraded. The overall average survival time was determined as 24.35 ± 9.91 years, the life expectancy reached 37.063 years in total, and the total mortality of patients suffering from pneumoconiosis was 28.03%. With disease progression, mean dust exposure duration, mean survival time, and life expectancy demonstrated progressive declines, whereas the number of people with lower economic levels, the proportion of small and medium-sized enterprises, along with age at onset and mortality rates, exhibited significant increases. Industries (mining, manufacturing), enterprise size (medium scale), first diagnostic stage (Stage III), and earlier age of onset were found as important risk factors for the survival of patients suffering from pneumoconiosis.

Stage III at initial diagnosis was an independent risk factor for mortality, while employment in mining/manufacturing, work in medium-sized enterprises, and younger age at onset also significantly increased the risk of death. Occupational health interventions should therefore focus on high-risk industries and enterprises, and enhance monitoring and management of both early-onset and advanced-stage patients. Delaying disease progression and implementing early health management are of critical public health importance for improving overall survival.