title: Continued decline in blood lead levels among adults in the United States: the National Health and Nutrition Examination Surveys.
abstract: BACKGROUND
  Declines in blood lead levels between 1976 and 1991 among US adults have been previously reported. More recent trends in blood lead levels and the association of lower blood lead levels with chronic disease have not been reported.
  
  
  METHODS
  Data from 2 nationally representative cross-sectional surveys, the Third National Health and Nutrition Examination Survey conducted in 1988-1994 (n = 16,609) and the National Health and Nutrition Examination Survey conducted in 1999-2002 (n = 9961) were analyzed.
  
  
  RESULTS
  The geometric mean blood lead level declined 41% from 2.76 microg/dL (0.13 micromol/L) in 1988-1994 to 1.64 microg/dL (0.08 micromol/L) in 1999-2002. The percentage of adults with blood lead levels of 10 microg/dL (0.48 micromol/L) or higher declined from 3.3% in 1988-1994 to 0.7% in 1999-2002 (P<.001). In 1999-2002, the multivariable-adjusted odds ratio of having a blood lead level of 10 microg/dL (0.48 micromol/L) or higher was 2.91 (95% confidence interval [CI], 1.74-4.84) and 3.26 (1.83-5.81) for non-Hispanic blacks and Mexican Americans, respectively, compared with non-Hispanic whites. After multivariable adjustment, persons in the highest quartile (>or=2.47 microg/dL [>or=0.12 micromol/L]) compared with those in the lowest quartile (<1.06 microg/dL [<0.05 micromol/L]) of blood lead levels were 2.72 (95% CI, 1.47-5.04) and 1.92 (95% CI, 1.02-3.61) times more likely to have chronic kidney disease and peripheral arterial disease, respectively. In addition, higher blood lead levels were associated with a higher multivariable-adjusted odds ratio of hypertension among non-Hispanic blacks and Mexican Americans.
  
  
  CONCLUSIONS
  Blood lead levels continue to decline among US adults, but racial and ethnic disparities persist. Higher blood lead levels remain associated with a higher burden of chronic kidney and peripheral arterial diseases among the overall population and with hypertension among non-Hispanic blacks and Mexican Americans.
authors.affiliation: Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA. pmuntner@tulane.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.forename: Andy
authors.initials: A
authors.lastname: Menke
authors.forename: Karen B
authors.initials: KB
authors.lastname: DeSalvo
authors.forename: Felicia A
authors.initials: FA
authors.lastname: Rabito
authors.forename: Vecihi
authors.initials: V
authors.lastname: Batuman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D004781:Environmental Exposure; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007854:Lead / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D044469:Racial Groups / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States
chemical_list: D007854:Lead