Introduction Pulmonary tuberculosis (PTB) is a major public health problem in South Africa and gold miners have the highest incidence of tuberculosis in the world. However, there is no systematic surveillance of occupational lung diseases in the mining industry. South African law allows for autopsy examination for the diagnosis of occupational lung diseases, including PTB, regardless of the cause of death and with consent from the next of kin. Since 1975, the autopsy findings have been stored on a computerised database (PATHAUT). We estimated temporal trends in the relative proportions of PTB and evaluated their use for disease surveillance.

Methods We extracted data from PATHAUT on all autopsies from 1975 to 2011. The data were stratified by population group because of differences in the patterns of exposure, employment and autopsy referral. Long-term PTB trends and potential determinants of these trends such as age, gold mining service, duration of employment and year of death, were evaluated using linear regression.

Results The crude proportions of PTB were higher in black than white miners. The proportion of black miners with PTB increased from 0.03 in 1975 to 0.3 in 2011 and from 0.01 to 0.06 in white miners. Most of the miners with PTB (79.3%) had been exposed to silica dust in the gold mining industry. The increasing PTB trend was primarily due to year of death, increasing age and employment duration in the gold mining industry.

Conclusions The high and increasing trend of PTB in the South African mining industry is of great concern. Our findings will be discussed in the context of high HIV prevalence and silica dust levels in the mining industry. Initiatives to control the epidemic are underway and the autopsy database provides data that can be used for the surveillance of PTB and monitoring of preventative interventions.