Lead Poisoning Prevention and Environmental Health Tracking Branch (Dr Dignam) and National Center for Chronic Disease Prevention and Health Promotion (Dr Kaufmann), Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia (Ms LeStourgeon); and Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Cambridge, Massachusetts (Dr Brown).
J Public Health Manag Pract. 2019 Jan/Feb;25 Suppl 1, Lead Poisoning Prevention(Suppl 1 LEAD POISONING PREVENTION):S13-S22. doi: 10.1097/PHH.0000000000000889.
During the past 45 years, exposure to lead has declined dramatically in the United States. This sustained decline is measured by blood and environmental lead levels and achieved through control of lead sources, emission reductions, federal regulations, and applied public health efforts.
Explore regulatory factors that contributed to the decrease in exposure to lead among the US population since 1970.
DESIGN/SETTING: We present historical information about the control of lead sources and the reduction of emissions through regulatory and selected applied public health efforts, which have contributed to decreases in lead exposure in the United States. Sources of lead exposure, exposure pathways, blood lead measurements, and special populations at risk are described.
From 1976-1980 to 2015-2016, the geometric mean blood lead level (BLL) of the US population aged 1 to 74 years dropped from 12.8 to 0.82 μg/dL, a decline of 93.6%. Yet, an estimated 500 000 children aged 1 to 5 years have BLLs at or above the blood lead reference value of 5 μg/dL established by the Centers for Disease Control and Prevention. Low levels of exposure can lead to adverse health effects. There is no safe level of lead exposure, and child BLLs less than 10 μg/dL are known to adversely affect IQ and behavior. When the exposure source is known, approximately 95% of BLLs of 25 μg/dL or higher are work-related among US adults. Despite much progress in reducing exposure to lead in the United States, there are challenges to eliminating exposure.
There are future challenges, particularly from the inequitable distribution of lead hazards among some communities. Maintaining federal, state, and local capacity to identify and respond to populations at high risk can help eliminate lead exposure as a public health problem. The results of this review show that the use of strong evidence-based programs and practices, as well as regulatory authority, can help control or eliminate lead hazards before children and adults are exposed.
在过去的 45 年中，美国的铅暴露量大幅下降。这一持续下降是通过血液和环境中的铅含量以及通过控制铅源、减排、联邦法规和应用公共卫生措施来衡量的。
探讨自 1970 年以来导致美国人口铅暴露减少的监管因素。
设计/设置：我们介绍了控制铅源和通过监管和选定的应用公共卫生措施减少排放的历史信息，这些措施有助于减少美国的铅暴露。描述了铅暴露的来源、暴露途径、血铅测量值和高危特殊人群。
从 1976-1980 年到 2015-2016 年，美国 1 至 74 岁人群的几何平均血铅水平（BLL）从 12.8μg/dL 降至 0.82μg/dL，下降了 93.6%。然而，据估计，仍有 50 万名 1 至 5 岁儿童的 BLL 处于疾病控制与预防中心设定的 5μg/dL 血铅参考值之上。低水平的接触也可能导致不良健康影响。没有安全的铅暴露水平，已知儿童 BLL 低于 10μg/dL 会对智商和行为产生不利影响。当暴露源已知时，美国成年人中约有 95%的 BLL 为 25μg/dL 或更高，与工作有关。尽管美国在减少铅暴露方面取得了很大进展，但仍面临消除暴露的挑战。
未来仍存在挑战，特别是在一些社区铅危害的不平等分布方面。保持联邦、州和地方的能力，以确定和应对高危人群，有助于消除铅暴露作为一个公共卫生问题。本综述的结果表明，使用强有力的循证方案和实践以及监管权力，可以帮助在儿童和成人暴露之前控制或消除铅危害。
