Lead poisoning epidemiology and demographics: Difference between revisions
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{{CMG}}; {{AE}} Aksiniya K. Stevasarova, MD | {{CMG}}; {{AE}} Aksiniya K. Stevasarova, MD | ||
==Overview== | ==Overview== | ||
*Lead constitutes 0.002% of the Earth’s crust, and in nature it exists mainly as lead sulphide. Lead has become widely distributed in the biosphere | |||
only in the past few thousand years, almost entirely as the result of human activity (National Research Council, 1972). Once lead is introduced into | |||
the environment, it persists. | |||
*The average person has less than 10 [[microgram]]s per [[deciliter]], or 100 [[parts per billion]], ppb, of lead in their blood. People who have been exposed to an unusual amount of lead will have blood lead levels higher than 200 ppb—most clinical symptoms of lead poisoning begin at around 100 ppb. The effect on children's mental/cognitive abilities has been noted at very low levels.<ref>{{cite web|url=http://www.ehponline.org/members/2005/7688/7688.pdf|title=Low Level Environmental Lead Exposure And Children's Intellectual Function: an International Pooled Analysis|publisher=Children's Health|accessdate=2007-09-09|author=Lanphear, Hornung, et al}}</ref> | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
===Incidence=== | ===Incidence=== | ||
*The incidence | *The incidence of [[lead poisoning]] is approximately one in 38 U.S. children in the United States. | ||
* | *Low income people often live in rental housing with lead paint, and unless the landlord conducts regular inspections, paint may begin to peel and residents will be exposed to high levels of lead paint dust, thus greatly increasing their chance of lead poisoning. | ||
===Prevalence=== | ===Prevalence=== | ||
*The | *The prevalence of [[lead poisoning]] in children, according to the [[CDC]], in the United States is estimated to be approximately half million children ages 1-5 with blood lead levels above 5 micrograms per deciliter (µg/dL). The percentage of children in the same age group with blood lead levels greater than or equal to 10 µg/dl has declined from 77.8% in the late 1970s to 4.4% in the early 1990s, and the average lead level of a child in the United States has declined to 1.9 µg/dl between 1999 and 2002. | ||
*In | *Today at least 4 million households have children living in them that are being exposed to high levels of lead. | ||
*In 1978 there were 13.5 million children in the United States with elevated blood lead levels (i.e., 10µg/dl). By 2002, that number had dropped to 310,000 children.<ref>{{cite web|url=http://www.epa.gov/lead/index.html|title=Lead in Paint, Dust, and Soil|publisher=United States Environmental Protection Agency|accessdate=2007-09-09}}</ref> The U.S. incurs $43.4 billion annually in the costs of all pediatric environmental disease, with childhood lead poisoning alone accounting for the vast majority of it.<ref>{{cite web|url=http://www.atsdr.cdc.gov/csem/lead/pbwhere_found2.html|date=2002|accessdate=2007-09-09|title=Lead Toxicity Cover Page|publisher=United States Center for Disease Control|title=Lead Toxicity: Where Is Lead Found?||publisher=United States Center for Disease Control|accessdate=2007-09-09}}</ref> | |||
===Case-fatality rate/Mortality rate=== | ===Case-fatality rate/Mortality rate=== | ||
* | *The case-fatality rate of [[lead poisoning]] is approximately 400,000 U.S. deaths per year. | ||
===Age=== | ===Age=== | ||
*Patients of all age groups may develop [ | *Patients of all age groups may develop [[lead poisoning]. | ||
*The incidence of [ | *The incidence of [[lead poisoning]] is higher in children; the median age at diagnosis is 1-5 years. | ||
*[ | *[[Lead poisoning]] commonly affects individuals younger than 10 years of age. | ||
*[Chronic | *[[Chronic lead poisoning] is usually first diagnosed adults. | ||
*[Acute | *[[Acute lead poisoning]] commonly affects children. | ||
*Children | |||
Lead-contaminated household dust is the major source of lead exposure to children in the U.S.<ref>{{cite web|url=http://www.atsdr.cdc.gov/csem/lead/pbwhere_found2.html|date=2002|accessdate=2007-09-09|title=Lead Toxicity Cover Page|publisher=United States Center for Disease Control|title=Lead Toxicity: Who Is at Risk of Lead Exposure?||publisher=United States Center for Disease Control|accessdate=2007-09-09}}</ref> | |||
A 2006 study in [[New York City]] found lead levels in settled outdoor dust, which is a source of household dust, of 175 to 730 μg/ft<sup>2</sup>, and noted that these levels exceed the [[United States Department of Housing and Urban Development|HUD]]/[[United States Environmental Protection Agency|EPA]] lead in indoor dust standard of 40 μg/ft<sup>2</sup>.<ref>{{cite journal|author=Caravanos J, Weiss AL, Blaise MJ, Jaeger RJ | title=A survey of spatially distributed exterior dust lead loadings in New York City | journal=Environmental Research | volume=100 | issue=2 |pages=165–172 | month=Feb | year=2006 | doi=10.1016/j.envres.2005.05.001}}</ref> | |||
*Adults | |||
Although children are at greater risk from lead exposure, adult exposures can also result in harmful health effects. Most adult exposures are occupational and occur in lead-related industries such as lead smelting, refining, and manufacturing industries. One frequent source of lead exposure to adults is home renovation that involves scraping, remodeling, or otherwise disturbing lead-based paint. Adults can also be exposed during certain hobbies and activities where lead is used. Workers may inhale lead dust and lead oxide fumes, as well as eat, drink, and smoke in or near contaminated areas, thereby increasing their probability of lead ingestion. Between 0.5 and 1.5 million US workers are exposed to lead in the workplace (ATSDR, 1999). Other than the developmental effects unique to young children, the health effects experienced by adults from adult exposures are similar to those experienced by children, although the thresholds are generally higher.<ref>{{cite web|url=http://www.atsdr.cdc.gov/csem/lead/pbwhoisat_risk2.html|accessdate=2007-09-09|title=Lead Toxicity: Who Is at Risk of Lead Exposure?|publisher=United States Center for Disease Control}}</ref> | |||
===Race=== | ===Race=== | ||
*There is no racial predilection to [ | *There is no racial predilection to [[lead poisoning]]. | ||
*[ | *[[Lead poisoning]] usually affects many people through household products, workplace, and lead paint, studies show that people of color and recent immigrants are at a much greater risk for high levels of exposure than whites <ref>www.leadsafekids.org</ref>. | ||
===Gender=== | ===Gender=== | ||
*[ | *[[Lead poisoning]] affects men and women equally. | ||
===Region=== | ===Region=== | ||
*The majority of [disease name] cases are reported in [geographical region]. | *The majority of [disease name] cases are reported in [geographical region]. | ||
| Line 41: | Line 55: | ||
===Developing Countries=== | ===Developing Countries=== | ||
=== Pathways === | === Pathways === | ||
Today almost everyone is exposed to environmental lead. Exposure to lead and lead chemicals can occur through inhalation, ingestion or occasionally dermal contact. Lead mining and lead smelting are common in many countries, where children and adults can receive substantial lead exposure from sources uncommon today in the U.S. Most countries will have phased out use of leaded gasoline by 2007. Lead exposure in the general population (including children) occurs primarily through ingestion, although inhalation also contributes to lead body burden and may be the major contributor for workers in lead-related occupations. Inhalation is the second major pathway of exposure. Almost all inhaled lead is absorbed into the body, whereas from 20% to 70% of ingested lead is absorbed (with children generally absorbing a higher percentage than adults do). Dermal exposure plays a role for exposure to organic lead among workers, but is not considered a significant pathway for the general population, except in areas where leaded gasoline is used. Organic lead from gasoline additives may be absorbed directly through the skin.<ref>{{cite web|url=http://www.atsdr.cdc.gov/csem/lead/pbroute_exposure2.html|accessdate=2007-09-09|title=Lead Toxicity: How Are People Exposed to Lead?|publisher=United States Center for Disease Control}}</ref> | Today almost everyone is exposed to environmental lead. Exposure to lead and lead chemicals can occur through inhalation, ingestion or occasionally dermal contact. Lead mining and lead smelting are common in many countries, where children and adults can receive substantial lead exposure from sources uncommon today in the U.S. Most countries will have phased out use of leaded gasoline by 2007. Lead exposure in the general population (including children) occurs primarily through ingestion, although inhalation also contributes to lead body burden and may be the major contributor for workers in lead-related occupations. Inhalation is the second major pathway of exposure. Almost all inhaled lead is absorbed into the body, whereas from 20% to 70% of ingested lead is absorbed (with children generally absorbing a higher percentage than adults do). Dermal exposure plays a role for exposure to organic lead among workers, but is not considered a significant pathway for the general population, except in areas where leaded gasoline is used. Organic lead from gasoline additives may be absorbed directly through the skin.<ref>{{cite web|url=http://www.atsdr.cdc.gov/csem/lead/pbroute_exposure2.html|accessdate=2007-09-09|title=Lead Toxicity: How Are People Exposed to Lead?|publisher=United States Center for Disease Control}}</ref> | ||
==References== | ==References== | ||
Revision as of 00:22, 16 June 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aksiniya K. Stevasarova, MD
Overview
- Lead constitutes 0.002% of the Earth’s crust, and in nature it exists mainly as lead sulphide. Lead has become widely distributed in the biosphere
only in the past few thousand years, almost entirely as the result of human activity (National Research Council, 1972). Once lead is introduced into the environment, it persists.
- The average person has less than 10 micrograms per deciliter, or 100 parts per billion, ppb, of lead in their blood. People who have been exposed to an unusual amount of lead will have blood lead levels higher than 200 ppb—most clinical symptoms of lead poisoning begin at around 100 ppb. The effect on children's mental/cognitive abilities has been noted at very low levels.[1]
Epidemiology and Demographics
Incidence
- The incidence of lead poisoning is approximately one in 38 U.S. children in the United States.
- Low income people often live in rental housing with lead paint, and unless the landlord conducts regular inspections, paint may begin to peel and residents will be exposed to high levels of lead paint dust, thus greatly increasing their chance of lead poisoning.
Prevalence
- The prevalence of lead poisoning in children, according to the CDC, in the United States is estimated to be approximately half million children ages 1-5 with blood lead levels above 5 micrograms per deciliter (µg/dL). The percentage of children in the same age group with blood lead levels greater than or equal to 10 µg/dl has declined from 77.8% in the late 1970s to 4.4% in the early 1990s, and the average lead level of a child in the United States has declined to 1.9 µg/dl between 1999 and 2002.
- Today at least 4 million households have children living in them that are being exposed to high levels of lead.
- In 1978 there were 13.5 million children in the United States with elevated blood lead levels (i.e., 10µg/dl). By 2002, that number had dropped to 310,000 children.[2] The U.S. incurs $43.4 billion annually in the costs of all pediatric environmental disease, with childhood lead poisoning alone accounting for the vast majority of it.[3]
Case-fatality rate/Mortality rate
- The case-fatality rate of lead poisoning is approximately 400,000 U.S. deaths per year.
Age
- Patients of all age groups may develop [[lead poisoning].
- The incidence of lead poisoning is higher in children; the median age at diagnosis is 1-5 years.
- Lead poisoning commonly affects individuals younger than 10 years of age.
- [[Chronic lead poisoning] is usually first diagnosed adults.
- Acute lead poisoning commonly affects children.
- Children
Lead-contaminated household dust is the major source of lead exposure to children in the U.S.[4] A 2006 study in New York City found lead levels in settled outdoor dust, which is a source of household dust, of 175 to 730 μg/ft2, and noted that these levels exceed the HUD/EPA lead in indoor dust standard of 40 μg/ft2.[5]
- Adults
Although children are at greater risk from lead exposure, adult exposures can also result in harmful health effects. Most adult exposures are occupational and occur in lead-related industries such as lead smelting, refining, and manufacturing industries. One frequent source of lead exposure to adults is home renovation that involves scraping, remodeling, or otherwise disturbing lead-based paint. Adults can also be exposed during certain hobbies and activities where lead is used. Workers may inhale lead dust and lead oxide fumes, as well as eat, drink, and smoke in or near contaminated areas, thereby increasing their probability of lead ingestion. Between 0.5 and 1.5 million US workers are exposed to lead in the workplace (ATSDR, 1999). Other than the developmental effects unique to young children, the health effects experienced by adults from adult exposures are similar to those experienced by children, although the thresholds are generally higher.[6]
Race
- There is no racial predilection to lead poisoning.
- Lead poisoning usually affects many people through household products, workplace, and lead paint, studies show that people of color and recent immigrants are at a much greater risk for high levels of exposure than whites [7].
Gender
- Lead poisoning affects men and women equally.
Region
- The majority of [disease name] cases are reported in [geographical region].
- [Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].
Developed Countries
Developing Countries
Pathways
Today almost everyone is exposed to environmental lead. Exposure to lead and lead chemicals can occur through inhalation, ingestion or occasionally dermal contact. Lead mining and lead smelting are common in many countries, where children and adults can receive substantial lead exposure from sources uncommon today in the U.S. Most countries will have phased out use of leaded gasoline by 2007. Lead exposure in the general population (including children) occurs primarily through ingestion, although inhalation also contributes to lead body burden and may be the major contributor for workers in lead-related occupations. Inhalation is the second major pathway of exposure. Almost all inhaled lead is absorbed into the body, whereas from 20% to 70% of ingested lead is absorbed (with children generally absorbing a higher percentage than adults do). Dermal exposure plays a role for exposure to organic lead among workers, but is not considered a significant pathway for the general population, except in areas where leaded gasoline is used. Organic lead from gasoline additives may be absorbed directly through the skin.[8]
References
- ↑ Lanphear, Hornung; et al. "Low Level Environmental Lead Exposure And Children's Intellectual Function: an International Pooled Analysis" (PDF). Children's Health. Retrieved 2007-09-09.
- ↑ "Lead in Paint, Dust, and Soil". United States Environmental Protection Agency. Retrieved 2007-09-09.
- ↑ "Lead Toxicity: Where Is Lead Found?". United States Center for Disease Control. 2002. Retrieved 2007-09-09.
- ↑ "Lead Toxicity: Who Is at Risk of Lead Exposure?". United States Center for Disease Control. 2002. Retrieved 2007-09-09.
- ↑ Caravanos J, Weiss AL, Blaise MJ, Jaeger RJ (2006). "A survey of spatially distributed exterior dust lead loadings in New York City". Environmental Research. 100 (2): 165&ndash, 172. doi:10.1016/j.envres.2005.05.001. Unknown parameter
|month=ignored (help) - ↑ "Lead Toxicity: Who Is at Risk of Lead Exposure?". United States Center for Disease Control. Retrieved 2007-09-09.
- ↑ www.leadsafekids.org
- ↑ "Lead Toxicity: How Are People Exposed to Lead?". United States Center for Disease Control. Retrieved 2007-09-09.