Do We Underestimate Risk of Cardiovascular Mortality Due to Lead Exposure?

Details

• Personal Author:
  Hu H ; Lee, Stephen A. ; Park SK ; Wang X
• Description:
  Background: Studies using data from the National Health and Nutrition Examination Survey-III (NHANES-III) have demonstrated significant prospective associations between blood lead levels and increased mortality. Bone lead represents cumulative lead burden and thus is a better biomarker for assessing chronic impacts, but its in vivo assessment requires special K-x-ray fluorescence (KXRF) instrumentation. Our team recently developed an algorithm predicting bone lead levels from a combination of blood lead levels, age and other socioeconomic and behavioral variables. We examined the associations of our algorithm-estimated bone lead levels and mortality in NHANES-III. Methods: We included 11,628 adults followed up to December 31, 2019. Estimated tibia lead and patella lead levels were calculated using our prediction algorithms. We used survey-weighted Cox proportional hazards models to compute hazard ratios (HRs) and 95 % confidence intervals (CIs). Results: During the median follow-up of 26.8 years, 4900 participants died (mortality rate = 1398 per 100,000 adults/year). Geometric means (95 % CIs) of blood lead, predicted tibia lead, and predicted patella lead were 2.69 µg/dL (2.54, 2.84), 6.73 µg/g (6.22, 7.25), and 16.3 µg/g (15.9, 16.8), respectively. The associations for all-cause mortality were similar between blood lead and bone lead. However, the associations for cardiovascular mortality were much greater with predicted bone lead markers compared to blood lead: for comparing participants at the 90th vs. 10th percentiles of exposure, HR = 3.32 (95 % CI: 1.93-5.73) for tibia lead, 2.42 (1.56-3.76) for patella lead, 1.63 (1.25-2.14) for blood lead. The population attributable fractions for cardiovascular disease mortality if everyone's lead concentrations were declined to the 10th percentiles were 45.8 % (95 % CI: 28.1-59.4) for tibia lead, 33.1 % (18.1-45.8) for patella lead, and 22.8 % (10.4-33.8) for blood lead. Conclusions: These findings suggest that risk assessment for cardiovascular mortality based on blood lead levels may underestimate the true mortality risk of lead exposure. [Description provided by NIOSH]
• Subjects:
  Biomarkers Cardiovascular Diseases Cardiovascular System Mortality Occupational Exposure Occupational Health Safety
• Keywords:
  Algorithms Blood Lead Levels Cardiovascular Disease Chronic Exposure Mortality Rates Risk Assessment
• ISSN:
  0048-9697
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  California ; Michigan ; OSHA Region 5 ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  923
• NIOSHTIC Number:
  nn:20069376
• Citation:
  Sci Total Environ 2024 May; 923:171511
• Contact Point Address:
  Sung Kyun Park, Departments of Epidemiology and Environmental Health Sciences, University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA
• Email:
  sungkyun@umich.edu
• CAS Registry Number:
  Lead (CAS RN 7439-92-1)
• Federal Fiscal Year:
  2024
• Performing Organization:
  University of Michigan, Ann Arbor
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Science of the Total Environment
• End Date:
  20280630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:502e8761f2fb01d921cfcf0d2449fd8fc4f7ce50d9fee9a4a8eec3acba47d7ef14ac4a4c707e5c9461cbc0c3c5376cf34cfa7421c4f7ba784a6b777794f9557a
• Download URL:
  https://stacks.cdc.gov/view/cdc/207865/cdc_207865_DS1.pdf
• File Type:
  [PDF - 1.83 MB ]