title: Blood lead levels and death from all causes, cardiovascular disease, and cancer: results from the NHANES III mortality study.
abstract: BACKGROUND
  Analyses of mortality data for participants examined in 1976-1980 in the second National Health and Nutrition Examination Survey (NHANES II) suggested an increased risk of mortality at blood lead levels > 20 microg/dL. Blood lead levels have decreased markedly since the late 1970s. In NHANES III, conducted during 1988-1994, few adults had levels > 20 microg/dL.
  
  
  OBJECTIVE
  Our objective in this study was to determine the risk of mortality in relation to lower blood lead levels observed for adult participants of NHANES III.
  
  
  METHODS
  We analyzed mortality information for 9,757 participants who had a blood lead measurement and who were > or = 40 years of age at the baseline examination. Using blood lead levels categorized as < 5, 5 to < 10, and > or = 10 microg/dL, we determined the relative risk of mortality from all causes, cancer, and cardiovascular disease through Cox proportional hazard regression analysis.
  
  
  RESULTS
  Using blood lead levels < 5 microg/dL as the referent, we determined that the relative risk of mortality from all causes was 1.24 [95% confidence interval (CI), 1.05-1.48] for those with blood levels of 5-9 microg/dL and 1.59 (95% CI, 1.28-1.98) for those with blood levels > or = 10 microg/dL (p for trend < 0.001). The magnitude of risk was similar for deaths due to cardiovascular disease and cancer, and tests for trend were statistically significant (p < 0.01) for both causes of death.
  
  
  CONCLUSIONS
  In a nationally representative sample of the U.S. population, blood lead levels as low as 5-9 mug/dL were associated with an increased risk of death from all causes, cardiovascular disease, and cancer.
authors.affiliation: Division of Health and Nutrition Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA. SSchober@cdc.gov
authors.forename: Susan E
authors.initials: SE
authors.lastname: Schober
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Mirel
authors.forename: Barry I
authors.initials: BI
authors.lastname: Graubard
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Brody
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Flegal
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D006801:Humans; D007854:Lead / Q000097:blood*; D008297:Male; D009369:Neoplasms / Q000097:blood / Q000401:mortality*; D009749:Nutrition Surveys; D016016:Proportional Hazards Models; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D007854:Lead