Zhang Yiwen, Xu Chengxu, Yu Junpu, Yang Jingli, Yu Shuxia, Li Nan, Yang Sangjiecao, Yang Aimin, Ma Li
School of Public Health, Lanzhou University, Lanzhou, 730000, China.
The Second Hospital of Lanzhou City, Lanzhou, 730030, China.
Biol Trace Elem Res. 2025 Jan;203(1):48-60. doi: 10.1007/s12011-024-04156-x. Epub 2024 Mar 28.
Long-term exposure to lead is associated with an increased risk of diabetic kidney disease (DKD). However, limited data exist on global trends in DKD burden attributable to lead exposure, especially across diverse regions categorized by socioeconomic level. We aimed to assess the spatiotemporal changes in DKD burden attributable to lead exposure from 1990 to 2019 across 204 countries and regions with varying socio-demographic index (SDI) metrics. This retrospective analysis utilized data from the Global Burden of Disease Study 2019 (GBD2019) database. We estimated the burden of DKD attributable to lead exposure using the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life year rate (ASDR), accounting for sex, age, nationality, and SDI. The annual percentage change (APC) and average annual percentage change (AAPC) were calculated using the Joinpoint model to evaluate trends in the ASMR and ASDR attributable to lead exposure from 1990 to 2019. Gaussian process regression was used to model the relationship between the SDI and ASMR/ASDR. Globally, the burden of DKD attributable to lead exposure has significantly increased since 1990, especially among elderly men and in regions such as Asia, Central Latin America, North Africa, the Middle East, and low-SDI regions. In 2019, the ASMR and ASDR of DKD attributable to lead exposure were 0.68 (95% CI: 0.40, 0.98) per 100,000 people and 15.02 (95% CI: 8.68, 22.26) per 100,000 people, respectively. From 1990 to 2019, the global ASMR and ASDR attributable to lead-associated DKD changed by 15.45% and -1.78%, respectively. The global AAPCs of the ASMR and ASDR were 0.55 (95% CI: 0.45, 0.65) and -0.01 (95% CI: -0.12, 0.1), respectively. Significant declining trends were observed in the high-income Asia Pacific region, eastern sub-Saharan Africa, North Africa, the Middle East, and other regions with high SDIs. Over this 30-year study period, the global burden of DKD attributable to lead exposure has increased, particularly in regions with low SDI. Lead exposure remains a significant concern in the global burden of diabetic kidney disease.
长期接触铅与糖尿病肾病（DKD）风险增加有关。然而，关于铅暴露所致DKD负担的全球趋势，尤其是在按社会经济水平分类的不同地区的数据有限。我们旨在评估1990年至2019年期间，在204个具有不同社会人口指数（SDI）指标的国家和地区中，铅暴露所致DKD负担的时空变化。这项回顾性分析利用了2019年全球疾病负担研究（GBD2019）数据库中的数据。我们使用年龄标准化死亡率（ASMR）和年龄标准化残疾调整生命年率（ASDR）来估计铅暴露所致DKD的负担，并考虑了性别、年龄、国籍和SDI。使用Joinpoint模型计算年度百分比变化（APC）和平均年度百分比变化（AAPC），以评估1990年至2019年期间铅暴露所致ASMR和ASDR的趋势。使用高斯过程回归来模拟SDI与ASMR/ASDR之间的关系。在全球范围内，自1990年以来，铅暴露所致DKD的负担显著增加，尤其是在老年男性以及亚洲、中拉丁美洲、北非、中东和低SDI地区等区域。2019年，铅暴露所致DKD的ASMR和ASDR分别为每10万人0.68（95%CI：0.40，0.98）和每10万人15.02（95%CI：8.68，22.26）。从1990年到2019年，与铅相关的DKD所致全球ASMR和ASDR分别变化了15.45%和-1.78%。ASMR和ASDR的全球AAPC分别为0.55（95%CI：0.45，0.65）和-0.01（95%CI：-0.12，0.1）。在高收入亚太地区、撒哈拉以南非洲东部、北非、中东以及其他高SDI地区观察到显著的下降趋势。在这30年的研究期内，铅暴露所致全球DKD负担有所增加，尤其是在低SDI地区。铅暴露仍然是糖尿病肾病全球负担中的一个重大问题。
