Low level environmental lead exposure--a continuing challenge.

The current threshold for lead toxicity, defined as a blood lead level of 10 microg/dL, was adopted by the United States (US) Centers for Disease Control and Prevention (CDC) in 1991 and the World Health Organization in 1995. Since that time, adverse health outcomes at blood lead levels below this threshold have been well demonstrated. Most concern probably relates to children of pre-school age; an international pooled analysis has demonstrated lead-associated intellectual deficits at blood lead levels well below 10 microg/dL. In the case of adults, several convincing population studies have shown a positive association between blood lead and risk of death. The largest such study compared mortality information from participants with blood lead levels in the highest third of the blood lead distribution (3.6 microg/dL or greater) with those in the lowest third (less than 1.9 microg/dL). After adjustment for potential confounders, estimates of the excess risk were 25% for all cause mortality and 55% for cardiovascular mortality. The adverse consequences of lead exposure have no discernible blood lead threshold, implying there is no safety margin at existing exposure levels. Despite marked declines in population mean blood lead levels since 1980, low level environmental lead exposure remains a significant public health concern.