title: Environmental determinants of different blood lead levels in children: a quantile analysis from a nationwide survey.
abstract: Blood lead levels (BLLs) have substantially decreased in recent decades in children in France. However, further reducing exposure is a public health goal because there is no clear toxicological threshold. The identification of the environmental determinants of BLLs as well as risk factors associated with high BLLs is important to update prevention strategies. We aimed to estimate the contribution of environmental sources of lead to different BLLs in children in France. We enrolled 484 children aged from 6months to 6years, in a nationwide cross-sectional survey in 2008-2009. We measured lead concentrations in blood and environmental samples (water, soils, household settled dusts, paints, cosmetics and traditional cookware). We performed two models: a multivariate generalized additive model on the geometric mean (GM), and a quantile regression model on the 10th, 25th, 50th, 75th and 90th quantile of BLLs. The GM of BLLs was 13.8μg/L (=1.38μg/dL) (95% confidence intervals (CI): 12.7-14.9) and the 90th quantile was 25.7μg/L (CI: 24.2-29.5). Household and common area dust, tap water, interior paint, ceramic cookware, traditional cosmetics, playground soil and dust, and environmental tobacco smoke were associated with the GM of BLLs. Household dust and tap water made the largest contributions to both the GM and the 90th quantile of BLLs. The concentration of lead in dust was positively correlated with all quantiles of BLLs even at low concentrations. Lead concentrations in tap water above 5μg/L were also positively correlated with the GM, 75th and 90th quantiles of BLLs in children drinking tap water. Preventative actions must target household settled dust and tap water to reduce the BLLs of children in France. The use of traditional cosmetics should be avoided whereas ceramic cookware should be limited to decorative purposes.
authors.affiliation: INSERM U1085, IRSET-Environmental and Occupational Health Research Institute, 2 avenue du Professeur Léon Bernard, 35043 RENNES Cedex, France. Electronic address: anne.etchevers@inserm.fr.
authors.forename: Anne
authors.initials: A
authors.lastname: Etchevers
authors.affiliation: InVS-French Institute for Public Health Surveillance, 12 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France. Electronic address: a.letertre@invs.sante.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Le Tertre
authors.affiliation: CSTB-Centre Scientifique et Technique du Bâtiment, 84 avenue Jean Jaurès, 77447 Marne-la-Vallée Cedex 2, France; University of South Brittany, UMR 6205, LMBA, F-56000 Vannes, France. Electronic address: JeanPaul.LUCAS@cstb.fr.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Lucas
authors.affiliation: Ministry of Health, 14 avenue Duquesne, 75350 Paris, France. Electronic address: philippe.bretin@sante.gouv.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bretin
authors.affiliation: Montreal University, Department of Environmental and Occupational Health, CHU Sainte-Justine, Chemin de la Côte Sainte-Catherine, Montreal H3T1A8, Canada. Electronic address: youssef.oulhote@umontreal.ca.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Oulhote
authors.affiliation: INSERM U1085, IRSET-Environmental and Occupational Health Research Institute, 2 avenue du Professeur Léon Bernard, 35043 RENNES Cedex, France; EHESP, Rennes, Sorbonne Paris Cité, Avenue du Professeur Léon-Bernard, 35043 Rennes Cedex, France. Electronic address: Barbara.LeBot@ehesp.fr.
authors.forename: Barbara
authors.initials: B
authors.lastname: Le Bot
authors.affiliation: INSERM U1085, IRSET-Environmental and Occupational Health Research Institute, 2 avenue du Professeur Léon Bernard, 35043 RENNES Cedex, France; EHESP, Rennes, Sorbonne Paris Cité, Avenue du Professeur Léon-Bernard, 35043 Rennes Cedex, France. Electronic address: Philippe.Glorennec@ehesp.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Glorennec
mesh_terms: D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D060766:Drinking Water / Q000032:analysis; D004391:Dust / Q000032:analysis; D004781:Environmental Exposure; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D007854:Lead / Q000032:analysis / Q000097:blood*; D008297:Male; D012307:Risk Factors
chemical_list: D060766:Drinking Water; D004391:Dust; D007854:Lead
keywords: Blood lead; Dust; Lead exposure; Soil; Water