Lustberg Mark, Silbergeld Ellen
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 660 W Redwood St, Baltimore, MD 21201, USA.
Arch Intern Med. 2002 Nov 25;162(21):2443-9. doi: 10.1001/archinte.162.21.2443.
Despite declines in blood lead levels during the past 20 years, lead exposure continues to be a public health concern. Studies have linked lead exposure with increased risk for diverse health outcomes. Few studies have evaluated the association of lead exposure and mortality in the general population.
To evaluate the association of lead exposure and mortality in the United States, we used the recently released mortality follow-up data for participants of the Second National Health and Nutrition Examination Survey, a national cross-sectional survey of the general population conducted from 1976 to 1980. Survey participants aged 30 to 74 years with blood lead measurements were followed up through December 31, 1992 (n = 4292).
After adjustment for potential confounders, individuals with baseline blood lead levels of 20 to 29 microg/dL (1.0-1.4 micromol/L) had 46% increased all-cause mortality (rate ratio [RR], 1.46; 95% confidence interval [CI], 1.14-1.86), 39% increased circulatory mortality (RR, 1.39; 95% CI, 1.01-1.91), and 68% increased cancer mortality (RR, 1.68; 95% CI, 1.02-2.78) compared with those with blood lead levels of less than 10 microg/dL (<0.5 micromol/L). All-cause mortality for those with blood lead levels of 10 to 19 microg/dL (0.5-0.9 micromol/L) was intermediately increased and not statistically significant (RR, 1.17; 95% CI, 0.90-1.52).
Individuals with blood lead levels of 20 to 29 micro g/dL in 1976 to 1980 (15% of the US population at that time) experienced significantly increased all-cause, circulatory, and cardiovascular mortality from 1976 through 1992. Thus, we strongly encourage efforts to reduce lead exposure for occupationally exposed workers and the 1.7 million Americans with blood lead levels of at least 20 micro g/dL (> or = 1.0 micromol/L).
尽管在过去20年中血铅水平有所下降，但铅暴露仍然是一个公共卫生问题。研究已将铅暴露与多种健康后果风险增加联系起来。很少有研究评估一般人群中铅暴露与死亡率之间的关联。
为了评估美国铅暴露与死亡率之间的关联，我们使用了最近发布的第二次全国健康与营养检查调查参与者的死亡率随访数据，该调查是1976年至1980年对一般人群进行的全国性横断面调查。对年龄在30至74岁且有血铅测量值的调查参与者进行随访，直至1992年12月31日（n = 4292）。
在对潜在混杂因素进行调整后，与血铅水平低于10微克/分升（<0.5微摩尔/升）的个体相比，基线血铅水平为20至29微克/分升（1.0 - 1.4微摩尔/升）的个体全因死亡率增加了46%（率比[RR]，1.46；95%置信区间[CI]，1.14 - 1.86），循环系统死亡率增加了39%（RR，1.39；95% CI，1.01 - 1.91），癌症死亡率增加了68%（RR，1.68；95% CI，1.02 - 2.78）。血铅水平为10至19微克/分升（0.5 - 0.9微摩尔/升）的个体全因死亡率中度增加但无统计学意义（RR，1.17；95% CI，0.90 - 1.52）。
1976年至1980年血铅水平为20至29微克/分升的个体（当时占美国人口的15%）在1976年至1992年期间全因、循环系统和心血管死亡率显著增加。因此，我们强烈鼓励努力降低职业暴露工人以及170万血铅水平至少为20微克/分升（≥1.0微摩尔/升）的美国人的铅暴露。
