Health effects of lead in Europe

About lead

Lead is present in the environment due to former application of lead in gasoline, leaded drinking water pipes, and use of lead in paints and other housing materials. Exposures to lead originate from various sources including air, drinking water, food stuff as well as surfaces and consumer products.

Lead is one of the most studied environmental pollutants and has been associated with a large number of health implications (WHO, 2007b). Exposure to lead may cause, amongst other things, kidney damage, miscarriages, effects of the nervous system, declined fertility, alterations in growth and endocrine function, and behavioural disruptions (Hauser et al. 2008; Lanphear et al., 2005; Selevan et al. 2003). Lead is a known neurotoxic pollutant affecting the development of the central nervous system of children and consequently their intelligence. Effects on attention, behaviour disorders and hearing-threshold changes have been described as particularly important (Needleman 1990, WHO/IPCS 1995). Lead exposures have also been shown to be associated with increased blood pressure and risk of hypertension in (female) adults (Nash et al. 2003). Correlations with low lead levels have been reported for the attention deficit hyperactivity disorder (ADHD) (Braun et al., 2006). In addition, there is evidence showing that lead may cause cancer. Lead has been loosely linked with cancers of the lung and stomach. IARC (2006b) rated lead and inorganic lead compounds as probably carcinogenic to humans (Group 2A). Current studies suggest that there is no “safe” level of lead exposure.

Most of the health endpoints are significant at much higher exposure levels that are found in European population today. Exposure to lead has significantly decreased for many countries in the last two decades, especially since the phasing out of leaded gasoline and the replacement of leaded water pipes. For example, Figure 3-3 shows the reduction of internal exposure to lead in humans in German students between the 1980s and now (German Environmental Specimen Bank [Umweltprobenbank des Bundes], data available online at www.umweltprobenbank.de). Indeed, lead has been the success story in environmental policies, but the follow-up in exposure data in the general population is poor.

FIGURE 3-4. Blood-Pb in German Students (1981–2009, geometric mean in μg/l, sampling location: city of Münster)

Selected health endpoints and exposure-response functions

The EBoDE project focuses on two endpoints that have been shown to be relevant at current exposure levels: mild mental retardation (due to IQ loss) and hypertensive disease (due to rise in systolic blood pressure). For the other health endpoints, i. a., no empirically sound exposure-response-relationships are available. Therefore, our results may underestimate the actual EBD of lead exposure in Europe. The extent of this underestimation cannot be quantified sufficiently.

The hypothesis of an effect threshold was rejected in several studies (Téllez-Rojo et al. 2006, Binns et al. 2007, Chiodo et al. 2004, Kordas et al. 2006). There is strong evidence for an association between B-Pb (blood lead) and negative effects on neuropsychological parameters at levels lower than 100 μg/l (Walkowiak et al., 1998; Canfield et al., 2004; Carta et al., 2005). Therefore, extending the dose-response curve to the range below 100 μg/l is possible. Lanphear et al. (2005) proposed a log-linear model for this curve.

Findings on lead’s effects on the central nervous system in the low-dose range are available from longitudinal and cross-sectional studies (Lanphear et al., 2005). These studies showed B-Pb and decrease in IQ points with B-Pb in children. The WHO model for IQ loss was recently updated to consider B-Pb levels above 24 μg/l. It has to be taken into account, however, that no threshold for mental retardation has been confirmed, yet. The exposure/response-function (ERF) in the WHO model is:

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