A meta-analysis of blood lead levels in India and the attributable burden of disease

Bret Ericson; Russell Dowling; Subhojit Dey; Jack Caravanos; Navya Mishra; Samantha Fisher; Myla Ramirez; Promila Sharma; Andrew McCartor; Pradeep Guin; Mark Patrick Taylor; Richard Fuller

doi:10.1016/j.envint.2018.08.047

A meta-analysis of blood lead levels in India and the attributable burden of disease

Environ Int. 2018 Dec;121(Pt 1):461-470. doi: 10.1016/j.envint.2018.08.047. Epub 2018 Sep 29.

Authors

Affiliations

¹ Pure Earth, 475 Riverside Drive, Suite 860, New York, NY 10025, USA; Department of Environmental Sciences, Faculty of Science and Engineering, Macquarie University, North Ryde, Sydney, NSW 2109, Australia. Electronic address: bret@pureearth.org.
² Pure Earth, 475 Riverside Drive, Suite 860, New York, NY 10025, USA.
³ Indian Institute of Public Health, Plot No. 47, Sector 44, Institutional Area Gurgaon, 122002 Delhi, Delhi NCR, India.
⁴ Pure Earth, 475 Riverside Drive, Suite 860, New York, NY 10025, USA; College of Global Public Health, New York University, 41 East 11th Street, New York, NY 10003, USA.
⁵ Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, 122002, Delhi NCR, India.
⁶ Jindal School of Government and Public Policy, O.P. Jindal Global University, Sonipat Narela Road, Sonipat 131001, Haryana, India.
⁷ Department of Environmental Sciences, Faculty of Science and Engineering, Macquarie University, North Ryde, Sydney, NSW 2109, Australia.

PMID: 30273869
DOI: 10.1016/j.envint.2018.08.047

Abstract

Multiple studies in India have found elevated blood lead levels (BLLs) in target populations. However the data have not yet been evaluated to understand population-wide exposure levels. We used arithmetic mean blood lead data published from 2010 to 2018 on Indian populations to calculate the average BLLs for multiple subgroups. We then calculated the attributable disease burden in IQ decrement and Disability Adjusted Life Years (DALYs). Our Pubmed search yielded 1066 articles. Of these, 31 studies representing the BLLs of 5472 people in 9 states met our study criteria. Evaluating these, we found a mean BLL of 6.86 μg/dL (95% CI: 4.38-9.35) in children and 7.52 μg/dL (95% CI: 5.28-9.76) in non-occupationally exposed adults. We calculated that these exposures resulted in 4.9 million DALYs (95% CI: 3.9-5.6) in the states we evaluated. Population-wide BLLs in India remain elevated despite regulatory action to eliminate leaded petrol, the most significant historical source. The estimated attributable disease burden is larger than previously calculated, particularly with regard to associated intellectual disability outcomes in children. Larger population-wide BLL studies are required to inform future calculations. Policy responses need to be developed to mitigate the worst exposures.

Keywords: Blood; Contamination; DALYs; India; Lead; Meta-analysis.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Cost of Illness*
Disabled Persons / statistics & numerical data
Environmental Exposure*
Environmental Pollutants / blood*
Humans
India
Lead / blood*
Quality-Adjusted Life Years*

Substances

Environmental Pollutants
Lead