Division of Health and Environment, Abt Associates Inc., Rockville, Maryland, USA.
Abt Associates Inc., Rockville, Maryland, USA.
Environ Health Perspect. 2020 Sep;128(9):97005. doi: 10.1289/EHP6552. Epub 2020 Sep 23.
Lead (Pb) is a highly toxic pollutant. Evidence suggests it is associated with cardiovascular disease (CVD)-related mortality.
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.
Building on previously conducted government literature reviews and a 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.
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.
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.
铅（Pb）是一种高度有毒的污染物。有证据表明，它与心血管疾病（CVD）相关死亡率有关。
我们提出了一种严格的方法，用于确定将成人 Pb 暴露与 CVD 死亡率相关联的浓度-反应函数，以为健康影响模型（HIM）提供信息。然后，我们在概念验证示例中使用该模型。
在先前进行的政府文献综述和补充文献综述的基础上，我们编译并评估了关于 Pb 和人类 CVD 死亡率的现有数据。我们应用了一套预先确定的选择标准，以确定最有助于了解 Pb 暴露对成人 CVD 死亡率风险影响的研究。一旦确定了研究，我们就得出了 HIM，并在概念验证示例中使用了每项研究的浓度-反应函数。
我们的文献检索确定了 15 项研究进行全文审查。在这 15 项研究中，有 4 项符合我们在 HIM 中使用的标准。使用 2014 年 40 岁至 80 岁人群的人口和 CVD 死亡率，我们估计，由于 1999 年至 2014 年血液 Pb 水平降低，已经避免了 34,000 至 99,000 例死亡。基于这些值，我们估计，1999 年至 2014 年 CVD 相关死亡率降低的 16%-46%可能归因于血液 Pb 水平降低。
我们的结果表明，减少 Pb 暴露可以为成年人群带来巨大的益处。我们提供了一种 HIM，可用于从疾病负担估计到监管影响评估的各种应用，并证明了其对浓度-反应函数选择的敏感性。https://doi.org/10.1289/EHP6552.
