Epidemiology of Lead Exposure

Since lead has been used widely for centuries, the effects of exposure are worldwide.[128] Environmental lead is ubiquitous, and everyone has some measurable blood lead level.[14][71] Lead is one of the largest environmental medicine problems in terms of numbers of people exposed and the public health toll it takes.[83] Lead exposure accounts for about 0.2% of all deaths and 0.6% of disability adjusted life years globally.[147]

Although regulation reducing lead in products has greatly reduced exposure in the developed world since the 1970s, lead is still allowed in products in many developing countries.[83] In all countries that have banned leaded gasoline, average blood lead levels have fallen sharply.[142] However, some developing countries still allow leaded gasoline,[128] which is the primary source of lead exposure in most developing countries.[106] Beyond exposure from gasoline, the frequent use of pesticides in developing countries adds a risk of lead exposure and subsequent poisoning.[148] Poor children in developing countries are at especially high risk for lead poisoning.[106] Of North American children, 7% have blood lead levels above 10 μg/dL, whereas among Central and South American children, the percentage is 33 to 34%.[128] About one fifth of the world's disease burden from lead poisoning occurs in the Western Pacific, and another fifth is in Southeast Asia.[128]

In developed countries, nonwhite people with low levels of education living in poorer areas are most at risk for elevated lead.[83] In the US, the groups most at risk for lead exposure are the impoverished, city-dwellers, and immigrants.[101] African-American children and those living in old housing have also been found to be at elevated risk for high blood lead levels in the US.[149] Low-income people often live in old housing with lead paint, which may begin to peel, exposing residents to high levels of lead-containing dust.

Risk factors for elevated lead exposure include alcohol consumption and smoking (possibly because of contamination of tobacco leaves with lead-containing pesticides).[71] Adults with certain risk factors might be more susceptible to toxicity; these include calcium and iron deficiencies, old age, disease of organs targeted by lead (e.g. the brain, the kidneys), and possibly genetic susceptibility.[112] Differences in vulnerability to lead-induced neurological damage between males and females have also been found, but some studies have found males to be at greater risk, while others have found females to be.[23]

In adults, blood lead levels steadily increase with increasing age.[9] In adults of all ages, men have higher blood lead levels than women do.[9] Children are more sensitive to elevated blood lead levels than adults are.[150] Children may also have a higher intake of lead than adults; they breathe faster and may be more likely to have contact with and ingest soil.[40] Children ages one to three tend to have the highest blood lead levels, possibly because at that age they begin to walk and explore their environment, and they use their mouths in their exploration.[23] Blood levels usually peak at about 18–24 months old.[7] In many countries including the US, household paint and dust are the major route of exposure in children.[40]

Estimated costs (billions) of pediatric disease of environmental origin, United States, 1997.

Disease

Best Estimate

Low Estimate

High Estimate

Lead Poisoning

$43.4  

$43.4

$43.4

Asthma

$2.0 

 $0.7

$2.3

Cancer

$0.3  

$0.2

$0.7

Neurobehavioral disorders

$9.2  

$4.6

$18.4

TOTAL

$54.9  

$48.8

$64.8