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.

中文翻译：

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根据美国社会经济地位估算铅造成的死亡负担


背景 本研究旨在估计美国按社会经济地位 (SES) 阶层分层的人口水平和州水平的铅归因死亡率负担。方法 根据国家健康和营养调查 (NHANES)，我们根据收入、就业、教育和保险数据构建了个人层面的 SES 分数。我们通过 NHANES 队列中的 Cox 回归评估了血铅水平 (BLL) 与全因死亡率之间的关联（n = 31 311，4467 例死亡）。根据估计的风险比 (HR) 以及中等 (2–5 μg/dL) 和高 (≥ 5 μg/dL) BLL 的患病率，我们计算了铅暴露引起的全因死亡率的 SES 分层人群归因分数 (PAF) 1999 年至 2019 年。我们还进行了系统审查，以估计州一级的铅所致死亡负担。结果 BLL 每增加 2 倍，HR 从最低 SES 类别的 1.23 (1.10–1.38) 降至最高 SES 类别的 1.05 (0.90–1.23)。在所有 SES 五分位数中，中等 BLL 表现出更大的死亡率负担。社会经济地位较低的个人的铅负担较高，而且这种差异在过去二十年中一直持续存在。 2017-19 年，美国每年有 67 000 例（32 000-112 000 例）死亡归因于铅暴露，其中 18 000 例（2000-41 000 例）死亡发生在最低社会经济地位类别。还强调了因铅暴露导致的州级死亡率负担的巨大差异。结论 这些发现表明，由于铅暴露的影响大小以及不同 SES 类别之间 BLL 的异质性，美国成年人中铅引起的死亡负担仍然存在差异。