Muntner Paul, Menke Andy, DeSalvo Karen B, Rabito Felicia A, Batuman Vecihi
Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA.
Arch Intern Med. 2005 Oct 10;165(18):2155-61. doi: 10.1001/archinte.165.18.2155.
Declines in blood lead levels between 1976 and 1991 among US adults have been previously reported. More recent trends in blood lead levels and the association of lower blood lead levels with chronic disease have not been reported.
Data from 2 nationally representative cross-sectional surveys, the Third National Health and Nutrition Examination Survey conducted in 1988-1994 (n = 16,609) and the National Health and Nutrition Examination Survey conducted in 1999-2002 (n = 9961) were analyzed.
The geometric mean blood lead level declined 41% from 2.76 microg/dL (0.13 micromol/L) in 1988-1994 to 1.64 microg/dL (0.08 micromol/L) in 1999-2002. The percentage of adults with blood lead levels of 10 microg/dL (0.48 micromol/L) or higher declined from 3.3% in 1988-1994 to 0.7% in 1999-2002 (P<.001). In 1999-2002, the multivariable-adjusted odds ratio of having a blood lead level of 10 microg/dL (0.48 micromol/L) or higher was 2.91 (95% confidence interval [CI], 1.74-4.84) and 3.26 (1.83-5.81) for non-Hispanic blacks and Mexican Americans, respectively, compared with non-Hispanic whites. After multivariable adjustment, persons in the highest quartile (>or=2.47 microg/dL [>or=0.12 micromol/L]) compared with those in the lowest quartile (<1.06 microg/dL [<0.05 micromol/L]) of blood lead levels were 2.72 (95% CI, 1.47-5.04) and 1.92 (95% CI, 1.02-3.61) times more likely to have chronic kidney disease and peripheral arterial disease, respectively. In addition, higher blood lead levels were associated with a higher multivariable-adjusted odds ratio of hypertension among non-Hispanic blacks and Mexican Americans.
Blood lead levels continue to decline among US adults, but racial and ethnic disparities persist. Higher blood lead levels remain associated with a higher burden of chronic kidney and peripheral arterial diseases among the overall population and with hypertension among non-Hispanic blacks and Mexican Americans.
此前已有报道称，1976年至1991年间美国成年人的血铅水平有所下降。但尚未有关于血铅水平的最新趋势以及较低血铅水平与慢性病之间关联的报道。
对两项具有全国代表性的横断面调查数据进行了分析，这两项调查分别是1988 - 1994年进行的第三次全国健康和营养检查调查（n = 16,609）以及1999 - 2002年进行的全国健康和营养检查调查（n = 9961）。
血铅水平的几何均值从1988 - 1994年的2.76微克/分升（0.13微摩尔/升）下降了41%，至1999 - 2002年的1.64微克/分升（0.08微摩尔/升）。血铅水平达到10微克/分升（0.48微摩尔/升）或更高的成年人比例从1988 - 1994年的3.3%降至1999 - 2002年的0.7%（P<0.001）。在1999 - 2002年，非西班牙裔黑人血铅水平达到10微克/分升（0.48微摩尔/升）或更高的多变量调整优势比为2.91（95%置信区间[CI]，1.74 - 4.84），墨西哥裔美国人则为3.26（1.83 - 5.81），相比之下，非西班牙裔白人的该优势比为1。经过多变量调整后，血铅水平处于最高四分位数（≥2.47微克/分升[≥0.12微摩尔/升]）的人群与处于最低四分位数（<1.06微克/分升[<0.05微摩尔/升]）的人群相比，患慢性肾病和外周动脉疾病的可能性分别高出2.72倍（95%CI，1.47 - 5.04）和1.92倍（95%CI，1.02 - 3.61）。此外，较高的血铅水平与非西班牙裔黑人和墨西哥裔美国人中经多变量调整后的高血压较高优势比相关。
美国成年人的血铅水平持续下降，但种族和族裔差异依然存在。较高的血铅水平在总体人群中仍与慢性肾病和外周动脉疾病的较高负担相关，在非西班牙裔黑人和墨西哥裔美国人中则与高血压相关。
