Abstract

Background:

Lead (Pb) is a highly toxic pollutant. Evidence suggests it is associated with cardiovascular disease (CVD)-related mortality.

Objectives:

We present a rigorous approach for identifying concentration–response functions that relate adult Pb exposures to CVD mortality to inform a health impact model (HIM). We then use the model in a proof-of-concept example.

Methods:

Building on previously conducted government literature reviews and a de novo supplemental literature review, we compiled and evaluated the available data on Pb and CVD mortality in humans. We applied a set of predefined selection criteria to identify studies that would be most useful in understanding the impact of Pb exposure on CVD mortality risk in adults. Once we identified the studies, we derived a HIM and used each study’s concentration–response function in a proof-of-concept example.

Results:

Our literature search identified 15 studies for full-text review. Of those 15 studies, 4 fit our criteria for use in the HIM. Using population and CVD mortality rates for 40- to 80-y-olds in 2014, we estimated that 34,000–99,000 deaths have been avoided due to the lowering of blood Pb levels from 1999 to 2014. Based on these values we estimated that approximately 16%–46% of the decreased CVD-related death rate from 1999 to 2014 may be attributable to decreased blood Pb levels.

Conclusion:

Our results demonstrate that decreases in Pb exposure can result in large benefits for the adult population. We have provided a HIM that can be used in a variety of applications from burden-of-disease estimates to regulatory impact assessments and have demonstrated its sensitivity to the choice of concentration–response function. https://doi.org/10.1289/EHP6552

中文翻译：

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开发成人铅暴露和心血管疾病死亡率的健康影响模型。

摘要

背景：

铅（Pb）是剧毒的污染物。有证据表明，它与心血管疾病（CVD）相关的死亡率有关。

目标：

我们提出了一种严格的方法，用于确定将成人铅暴露与CVD死亡率相关联的浓度-反应功能，以告知健康影响模型（HIM）。然后，我们在概念验证示例中使用该模型。

方法：

在先前进行的政府文献综述和从头补充文献综述的基础上，我们汇编并评估了有关人体铅和CVD死亡率的可用数据。我们应用了一组预定义的选择标准，以识别对了解铅暴露对成人CVD死亡风险的影响最有用的研究。一旦我们确定了研究，我们就得出了HIM，并在概念验证的例子中使用了每个研究的浓度反应功能。

结果：

我们的文献检索确定了15篇全文研究的研究。在这15项研究中，有4项符合我们在HIM中使用的标准。根据2014年40至80岁人群的人口和CVD死亡率，我们估计由于避免了1999年至2014年血铅水平的下降，避免了34,000–99,000人的死亡。基于这些值，我们估计大约有16人从1999年至2014年，与CVD相关的死亡率下降的百分比–46％可能归因于血铅水平下降。

结论：

我们的结果表明，铅暴露的减少可以为成年人群带来巨大的好处。我们提供了一种HIM，可用于从疾病负担估算到监管影响评估的各种应用，并证明了其对浓度-反应功能选择的敏感性。https://doi.org/10.1289/EHP6552