Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Mar;75(3):603-614.
doi: 10.1161/HYPERTENSIONAHA.119.14217. Epub 2020 Feb 3.

Interpretation of Population Health Metrics: Environmental Lead Exposure as Exemplary Case

Jan A Staessen  1   2   3 , Lutgarde Thijs  1 , Wen-Yi Yang  1   4 , Cai-Guo Yu  1   5 , Fang-Fei Wei  1 , Harry A Roels  6 , Tim S Nawrot  6 , Zhen-Yu Zhang  1
Affiliations
Review

Interpretation of Population Health Metrics: Environmental Lead Exposure as Exemplary Case

Jan A Staessen et al. Hypertension. 2020 Mar.

Abstract

Our objective was to gain insight in the calculation and interpretation of population health metrics that inform disease prevention. Using as model environmental exposure to lead (ELE), a global pollutant, we assessed population health metrics derived from the Third National Health and Nutrition Examination Survey (1988 to 1994), the GBD (Global Burden of Disease Study 2010), and the Organization for Economic Co-operation and Development. In the National Health and Nutrition Examination Survey, the hazard ratio relating mortality over 19.3 years of follow-up to a blood lead increase at baseline from 1.0 to 6.7 µg/dL (10th-90th percentile interval) was 1.37 (95% CI, 1.17-1.60). The population-attributable fraction of blood lead was 18.0% (10.9%-26.1%). The number of preventable ELE-related deaths in the United States would be 412 000 per year (250 000-598 000). In GBD 2010, deaths and disability-adjusted life-years globally lost due to ELE were 0.67 million (0.58-0.78 million) and 0.56% (0.47%-0.66%), respectively. According to the 2017 Organization for Economic Co-operation and Development statistics, ELE-related welfare costs were $1 676 224 million worldwide. Extrapolations from the foregoing metrics assumed causality and reversibility of the association between mortality and blood lead, which at present-day ELE levels in developed nations is not established. Other issues limiting the interpretation of ELE-related population health metrics are the inflation of relative risk based on outdated blood lead levels, not differentiating relative from absolute risk, clustering of risk factors and exposures within individuals, residual confounding, and disregarding noncardiovascular disease and immigration in national ELE-associated welfare estimates. In conclusion, this review highlights the importance of critical thinking in translating population health metrics into cost-effective preventive strategies.

Keywords: environmental exposure; lead; mortality; risk factors; welfare costs.

PubMed Disclaimer

Figures

Figure.
Figure.
Immigrant population in Belgium in 2018, by country of origin.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Staessen J, Bulpitt CJ, Roels H, Bernard A, Fagard R, Joossens JV, Lauwerys R, Lijnen P, Amery A. Urinary cadmium and lead concentrations and their relation to blood pressure in a population with low exposure. Br J Ind Med. 1984;41:241–248. doi: 10.1136/oem.41.2.241. - PMC - PubMed
    1. Staessen JA, Roels H, Fagard R for the PheeCad Investigators. Lead exposure and conventional and ambulatory blood pressure. A prospective population study. J Am Med Ass. 1996;275:1563–1570. - PubMed
    1. Yang WY, Efremov L, Mujaj B, Zhang ZY, Wei FF, Huang QF, Thijs L, Vanassche T, Nawrot TS, Staessen JA. Association of office and ambulatory blood pressure with blood lead in workers before occupational exposure. J Am Soc Hypertens. 2018;12:14–24. doi: 10.1016/j.jash.2017.10.010. - PubMed
    1. Staessen JA, Lauwerys RR, Buchet JP, Bulpitt CJ, Rondia D, Vanrenterghem Y, Amery A. Impairment of renal function with increasing blood lead concentrations in the general population. The Cadmibel Study Group. N Engl J Med. 1992;327:151–156. doi: 10.1056/NEJM199207163270303. - PubMed
    1. Staessen JA, Nawrot T, Hond ED, Thijs L, Fagard R, Hoppenbrouwers K, Koppen G, Nelen V, Schoeters G, Vanderschueren D, et al. Renal function, cytogenetic measurements, and sexual development in adolescents in relation to environmental pollutants: a feasibility study of biomarkers. Lancet. 2001;357:1660–1669. doi: 10.1016/s0140-6736(00)04822-4. - PubMed

Publication types