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Kuempel ED et al. - Emphysema severity was significantly elevated in coal miners compared to non-miners, among both ever and never smokers. Cumulative exposure to respirable coal mine dust or coal dust retained in the lungs were each significant predictors of emphysema severity, after accounting for cigarette smoking, age at death, and race. The contributions of coal mine dust exposure and cigarette smoking were similar in predicting emphysema severity averaged over this cohort. The study concludes that coal dust exposure, cigarette smoking, age, and race are significant and additive predictors of emphysema severity in this study.

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