title: The Global Burden of Lead Toxicity Attributable to Informal Used Lead-Acid Battery Sites.
abstract: Prior calculations of the burden of disease from environmental lead exposure in low- and middle-income countries (LMICs) have not included estimates of the burden from lead-contaminated sites because of a lack of exposure data, resulting in an underestimation of a serious public health problem.
  
  
  
  We used publicly available statistics and detailed site assessment data to model the number of informal used lead-acid battery (ULAB) recyclers and the resulting exposures in 90 LMICs. We estimated blood lead levels (BLLs) using the US Environment Protection Agency's Integrated Exposure Uptake Biokinetic Model for Lead in Children and Adult Lead Model. Finally, we used data and algorithms generated by the World Health Organization to calculate the number of attributable disability adjusted life years (DALYs).
  
  
  
  We estimated that there are 10,599 to 29,241 informal ULAB processing sites where human health is at risk in the 90 countries we reviewed. We further estimated that 6 to 16.8 million people are exposed at these sites and calculate a geometric mean BLL for exposed children (0-4 years of age) of 31.15 μg/dL and a geometric mean BLL for adults of 21.2 μg/dL. We calculated that these exposures resulted in 127,248 to 1,612,476 DALYs in 2013.
  
  
  
  Informal ULAB processing is currently causing widespread lead poisoning in LMICs. There is an urgent need to identify and mitigate exposures at existing sites and to develop appropriate policy responses to minimize the creation of new sites.
authors.affiliation: Pure Earth, New York, NY; Department of Environmental Sciences, Faculty of Science and Engineering, Macquarie University, North Ryde, Sydney, Australia; City University of New York School of Public Health, New York, NY. Electronic address: bret@pureearth.org.
authors.forename: Bret
authors.initials: B
authors.lastname: Ericson
authors.affiliation: Department of Pediatrics, Mount Sinai School of Medicine, New York, NY.
authors.forename: Phillip
authors.initials: P
authors.lastname: Landrigan
authors.affiliation: Department of Environmental Sciences, Faculty of Science and Engineering, Macquarie University, North Ryde, Sydney, Australia.
authors.forename: Mark Patrick
authors.initials: MP
authors.lastname: Taylor
authors.affiliation: Institute for Health Metrics and Evaluation, Seattle, WA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Frostad
authors.affiliation: Pure Earth, New York, NY; College of Global Public Health, New York University, New York, NY.
authors.forename: Jack
authors.initials: J
authors.lastname: Caravanos
authors.affiliation: Pure Earth, New York, NY.
authors.forename: John
authors.initials: J
authors.lastname: Keith
authors.affiliation: Pure Earth, New York, NY.
authors.forename: Richard
authors.initials: R
authors.lastname: Fuller
mesh_terms: D017281:Cost of Illness; D011211:Electric Power Supplies; D004781:Environmental Exposure / Q000009:adverse effects*; D004785:Environmental Pollutants / Q000032:analysis*; D064371:Hazardous Waste Sites; D006801:Humans; D007854:Lead / Q000633:toxicity*; D007855:Lead Poisoning / Q000453:epidemiology*; D019057:Quality-Adjusted Life Years
chemical_list: D004785:Environmental Pollutants; D007854:Lead
keywords: disability adjusted life years; informal economy; lead poisoning; low- and middle-income countries; recycling; soil pollution