title: The relationship between blood lead levels and neurobehavioral test performance in NHANES III and related occupational studies.
abstract: OBJECTIVE
  The goals of this study were two-fold: (1) to assess the relationship between blood lead levels and neurobehavioral test performance in a nationally sample of adults from the third National Health and Nutrition Evaluation Survey and (2) to analyze the results from previously published studies of occupational lead exposure that used the same neurobehavioral tests as those included in the survey.
  
  
  METHODS
  Regression models were used to test and estimate the relationships between measurements of blood lead and performance on a simple reaction time, a symbol-digit substitution, and a serial digit learning test in adults aged 20-59 years who participated the survey. Mixed models were used to analyze the data from the occupational studies.
  
  
  RESULTS
  The blood lead levels of those participating in the survey ranged from 0.7 to 41.8 microg/dl. The estimated geometric mean was 2.51 microg/dl, and the estimated arithmetic mean was 3.30 microg/dl. In the survey, no statistically significant relationships were found between blood lead concentration and performance on the three neurobehavioral tests when adjusted for covariates. In the occupational studies, the groups exposed to lead consistently performed worse than control groups on the simple reaction time and digit-symbol substitution tests.
  
  
  CONCLUSIONS
  The results from the survey and the occupational studies do not provide evidence for impairment of neurobehavioral test performance at levels below 25 microg/dl, the concentration that the Centers for Disease Control and Prevention define as elevated in adults. The average blood lead level of the exposed groups in the occupational studies was 41.07 microg/dl, less than 50 microg/dl, the minimum concentration that the Occupational Safety and Health Administration requires for medical removal from the workplace. Given the evidence of impaired neurobehavioral performance in these groups, the 50 microg/dl limit should be reevaluated.
authors.affiliation: Division of Applied Research and Technology, National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA. erk3@cdc.gov
authors.forename: Edward F
authors.initials: EF
authors.lastname: Krieg
authors.forename: David W
authors.initials: DW
authors.lastname: Chrislip
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Crespo
authors.forename: W Stephen
authors.initials: WS
authors.lastname: Brightwell
authors.forename: Richard L
authors.initials: RL
authors.lastname: Ehrenberg
authors.forename: David A
authors.initials: DA
authors.lastname: Otto
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007854:Lead / Q000097:blood*; D020265:Lead Poisoning, Nervous System, Adult / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D008297:Male; D008606:Mental Processes; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology; D009483:Neuropsychological Tests; D009749:Nutrition Surveys; D016273:Occupational Exposure / Q000009:adverse effects*; D011930:Reaction Time; D014481:United States
chemical_list: D007854:Lead