Abstract: Objective To determine the role of serum VEGF-Ab in pneumoconiosis of coal workers. Methods Four groups of participants were recruited for this study, including 230 with early stage (less serious than stage one) changes in relation to pneumoconiosis, 328 with confirmed coal worker pneumoconiosis, 309 workers exposed to coal dust, and 393 healthy people. All participants completed a questionnaire, and have their peripheral venous blood sample taken. Serum VEGF-Ab was detected by ELISA. Results Compared with healthy controls and those with early stage changes, the participants with pneumoconiosis and those exposed to coal dust had higher levels of serum VEGF-Ab (P<0.05). The level of serum VEGF-Ab increased with the progression of stages of pneumoconiosis but without statistical significance (P>0.05). In those with early stage pneumoconiosis, higher levels of serum VEGF-Ab were found in their 20 yr.- and 40 yr.- compared with those in their 60 yr.- (P<0.05). By contrast, in those with confirmed pneumoconiosis and the healthy controls, lower levels of serum VEGF-Ab were found in their 20 yr.- and 40 yr.- compared with those in their 60 yr.- (P<0.05). In those with early stage or first-stage pneumoconiosis, longer than 25 years work experience was associated with higher levels of serum VEGF-Ab (P<0.05). In those with confirmed pneumoconiosis, coal mining workers had a higher level of serum VEGF-Ab than their colleagues involving in assistance tasks (P<0.05). In those exposed to coal dust, tunnelling workers had a higher level of serum VEGF-Ab than their coal mining colleagues (P<0.05). Conclusion Serum VEGF-Ab is associated with the occurrence and development of coal worker pneumoconiosis. The level of serum VEGF-Ab increases with age and length of exposure to dust.