Abstract：
BACKGROUND: This study aimed to estimate population-level and state-level lead-attributable mortality burdens stratified by socioeconomic status (SES) class in the USA.
METHODS: Based on the National Health and Nutrition Examination Survey (NHANES), we constructed individual-level SES scores from income, employment, education and insurance data. We assessed the association between the blood lead levels (BLL) and all-cause mortality by Cox regression in the NHANES cohort (n = 31 311, 4467 deaths). With estimated hazard ratios (HR) and prevalences of medium (2-5 μg/dL) and high (≥ 5 μg/dL) BLL, we computed SES-stratified population-attributable fractions (PAFs) of all-cause mortality from lead exposure across 1999-2019. We additionally conducted a systematic review to estimate the lead-attributable mortality burden at state-level.
RESULTS: The HR for every 2-fold increase in the BLL decreased from 1.23 (1.10-1.38) for the lowest SES class to 1.05 (0.90-1.23) for the highest SES class. Across all SES quintiles, medium BLL exhibited a greater mortality burden. Individuals with lower SES had higher lead-attributable burdens, and such disparities haver persisted over the past two decades. In 2017-19, annually 67 000 (32 000-112 000) deaths in the USA were attributable to lead exposure, with 18 000 (2000-41 000) of these deaths occurring in the lowest SES class. Substantial disparities in the state-level mortality burden attributable to lead exposure were also highlighted.
CONCLUSIONS: These findings suggested that disparities in lead-attributable mortality burden persisted within US adults, due to heterogeneities in the effect sizes of lead exposure as well as in the BLL among different SES classes.
METHODS: Based on the National Health and Nutrition Examination Survey (NHANES), we constructed individual-level SES scores from income, employment, education and insurance data. We assessed the association between the blood lead levels (BLL) and all-cause mortality by Cox regression in the NHANES cohort (n = 31 311, 4467 deaths). With estimated hazard ratios (HR) and prevalences of medium (2-5 μg/dL) and high (≥ 5 μg/dL) BLL, we computed SES-stratified population-attributable fractions (PAFs) of all-cause mortality from lead exposure across 1999-2019. We additionally conducted a systematic review to estimate the lead-attributable mortality burden at state-level.
RESULTS: The HR for every 2-fold increase in the BLL decreased from 1.23 (1.10-1.38) for the lowest SES class to 1.05 (0.90-1.23) for the highest SES class. Across all SES quintiles, medium BLL exhibited a greater mortality burden. Individuals with lower SES had higher lead-attributable burdens, and such disparities haver persisted over the past two decades. In 2017-19, annually 67 000 (32 000-112 000) deaths in the USA were attributable to lead exposure, with 18 000 (2000-41 000) of these deaths occurring in the lowest SES class. Substantial disparities in the state-level mortality burden attributable to lead exposure were also highlighted.
CONCLUSIONS: These findings suggested that disparities in lead-attributable mortality burden persisted within US adults, due to heterogeneities in the effect sizes of lead exposure as well as in the BLL among different SES classes.
摘要：
背景：本研究旨在估计美国按社会经济地位（SES）等级分层的人口水平和州水平的铅归因死亡率负担。
方法：基于国家健康和营养调查（NHANES），我们从收入中构建了个人水平的SES分数，employment,教育和保险数据。我们通过Cox回归评估了NHANES队列中血铅水平（BLL）与全因死亡率之间的关系（n=31311，4467例死亡）。使用估计的危险比（HR）和培养基（2-5μg/dL）和高（≥5μg/dL）BLL的患病率，我们计算了1999-2019年铅暴露导致的全因死亡率的SES分层人群归因分数(PAFs).我们还进行了系统评价，以估计州一级的铅可归因死亡率负担。
结果：BLL每增加2倍的HR从最低SES等级的1.23（1.10-1.38）下降到最高SES等级的1.05（0.90-1.23）。在所有SES五分位数中，中等BLL表现出更大的死亡负担。SES较低的个人有较高的铅归因负担，这种差距在过去的二十年里一直存在。在2017-19年度，美国每年有67,000（32,000-112,000）例死亡可归因于铅暴露，其中18000例(2000-41000例)死亡发生在最低的SES类别。还强调了可归因于铅暴露的州一级死亡率负担的巨大差异。
结论：这些研究结果表明，在美国成年人中，可归因于铅的死亡负担存在差异。由于不同SES类别之间的铅暴露效应大小以及BLL中的异质性。
方法：基于国家健康和营养调查（NHANES），我们从收入中构建了个人水平的SES分数，employment,教育和保险数据。我们通过Cox回归评估了NHANES队列中血铅水平（BLL）与全因死亡率之间的关系（n=31311，4467例死亡）。使用估计的危险比（HR）和培养基（2-5μg/dL）和高（≥5μg/dL）BLL的患病率，我们计算了1999-2019年铅暴露导致的全因死亡率的SES分层人群归因分数(PAFs).我们还进行了系统评价，以估计州一级的铅可归因死亡率负担。
结果：BLL每增加2倍的HR从最低SES等级的1.23（1.10-1.38）下降到最高SES等级的1.05（0.90-1.23）。在所有SES五分位数中，中等BLL表现出更大的死亡负担。SES较低的个人有较高的铅归因负担，这种差距在过去的二十年里一直存在。在2017-19年度，美国每年有67,000（32,000-112,000）例死亡可归因于铅暴露，其中18000例(2000-41000例)死亡发生在最低的SES类别。还强调了可归因于铅暴露的州一级死亡率负担的巨大差异。
结论：这些研究结果表明，在美国成年人中，可归因于铅的死亡负担存在差异。由于不同SES类别之间的铅暴露效应大小以及BLL中的异质性。
