Our objective was to gain insight in the calculation and interpretation of population health metrics that inform disease prevention. Using as model environmental exposure to lead (ELE), a global pollutant, we assessed population health metrics derived from the Third National Health and Nutrition Examination Survey (1988 to 1994), the GBD (Global Burden of Disease Study 2010), and the Organization for Economic Co-operation and Development. In the National Health and Nutrition Examination Survey, the hazard ratio relating mortality over 19.3 years of follow-up to a blood lead increase at baseline from 1.0 to 6.7 µg/dL (10th–90th percentile interval) was 1.37 (95% CI, 1.17–1.60). The population-attributable fraction of blood lead was 18.0% (10.9%–26.1%). The number of preventable ELE-related deaths in the United States would be 412 000 per year (250 000–598 000). In GBD 2010, deaths and disability-adjusted life-years globally lost due to ELE were 0.67 million (0.58–0.78 million) and 0.56% (0.47%–0.66%), respectively. According to the 2017 Organization for Economic Co-operation and Development statistics, ELE-related welfare costs were $1 676 224 million worldwide. Extrapolations from the foregoing metrics assumed causality and reversibility of the association between mortality and blood lead, which at present-day ELE levels in developed nations is not established. Other issues limiting the interpretation of ELE-related population health metrics are the inflation of relative risk based on outdated blood lead levels, not differentiating relative from absolute risk, clustering of risk factors and exposures within individuals, residual confounding, and disregarding noncardiovascular disease and immigration in national ELE-associated welfare estimates. In conclusion, this review highlights the importance of critical thinking in translating population health metrics into cost-effective preventive strategies.

中文翻译：

---

人口健康指标解读

我们的目标是深入了解为疾病预防提供信息的人口健康指标的计算和解释。作为模型环境暴露于铅 (ELE)，一种全球污染物，我们评估了来自第三次国家健康和营养检查调查（1988 年至 1994 年）、GBD（2010 年全球疾病负担研究）和组织的人口健康指标。经济合作与发展。在国家健康和营养检查调查中，19.3 年随访期间死亡率与基线血铅从 1.0 到 6.7 µg/dL（第 10-90 个百分位区间）相关的风险比为 1.37（95% CI，1.17 –1.60）。可归因于人群的血铅比例为 18.0% (10.9%–26.1%)。美国每年可预防的 ELE 相关死亡人数为 412 000 (250 000–598 000)。在 GBD 2010 中，全球因 ELE 而损失的死亡和伤残调整生命年分别为 67 万（0.58-78 万）和 0.56%（0.47%-0.66%）。根据经济合作与发展组织 2017 年的统计数据，全球与 ELE 相关的福利费用为 16.76224 亿美元。从上述指标推断出的死亡率与血铅之间的关联具有因果关系和可逆性，而目前发达国家的 ELE 水平尚未确定。限制与 ELE 相关人口健康指标解释的其他问题是基于过时血铅水平的相对风险的膨胀，而不是区分相对风险和绝对风险，在国家 ELE 相关福利估计中，风险因素和个体内暴露的聚类、残留混杂和无视非心血管疾病和移民。总之，本综述强调了批判性思维在将人口健康指标转化为具有成本效益的预防策略方面的重要性。