Trends in Blood Lead Levels in the U.S. From 1999 to 2016

Published:January 20, 2021DOI:


      Trends in blood lead levels in the same birth cohort (generation) are necessary to identify the lead load in the population. This analysis uses a nationally representative sample to investigate the trends in blood lead levels from 1999 to 2016 by birth cohort and to revisit the association between blood lead levels and age.


      Data from the 1996 to 2016 National Health and Nutrition Examination Surveys were used to describe the distribution of blood lead levels. Trends in blood lead levels were analyzed using joinpoint regression models. Association of blood lead levels with age was conducted with both cross-sectional and birth cohort analysis. Analyses were conducted in 2020.


      In total, 68,877 participants were included (weighted mean age=38.4 years, 50.6% female). From 1999 to 2016, the geometric mean of blood lead levels decreased from 1.68 µg/dL (95% CI=1.63, 1.74) to 0.82 µg/dL (95% CI=0.77, 0.87). The annual percentage change estimated by the joinpoint model was –4.26% (p<0.05). The associations between blood lead levels and age were “U”-shaped by cross-sectional analysis, with higher risks for the lowest and highest ages. However, by birth cohort analysis the blood lead levels declined monotonically with age. The joinpoint analysis indicated the inflection point of age 13–17 years and statistically significant differences in decline slopes before and after this age.


      In this nationally representative study of the U.S. population, estimates of blood lead levels showed an overall decrease from 1999 to 2016. Blood lead levels are highest in childhood.
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        • Flora G
        • Gupta D
        • Tiwari A
        Toxicity of lead: a review with recent updates.
        Interdiscip Toxicol. 2012; 5: 47-58
        • American Academy of Pediatrics Committee on Environmental Health
        Lead exposure in children: prevention, detection, and management.
        Pediatrics. 2005; 116: 1036-1046
        • Sanders AP
        • Mazzella MJ
        • Malin AJ
        • et al.
        Combined exposure to lead, cadmium, mercury, and arsenic and kidney health in adolescents age 12-19 in NHANES 2009-2014.
        Environ Int. 2019; 131104993
        • Scinicariello F
        • Abadin HG
        • Murray HE
        Association of low-level blood lead and blood pressure in NHANES 1999-2006.
        Environ Res. 2011; 111: 1249-1257
        • Ruiz-Hernandez A
        • Navas-Acien A
        • Pastor-Barriuso R
        • et al.
        Declining exposures to lead and cadmium contribute to explaining the reduction of cardiovascular mortality in the U.S. population, 1988-2004.
        Int J Epidemiol. 2017; 46: 1903-1912
        • Menke A
        • Muntner P
        • Batuman V
        • Silbergeld EK
        • Guallar E
        Blood lead below 0.48 micromol/L (10 microg/dL) and mortality among U.S. adults.
        Circulation. 2006; 114: 1388-1394
        • Dórea JG
        Environmental exposure to low-level lead (Pb) co-occurring with other neurotoxicants in early life and neurodevelopment of children.
        Environ Res. 2019; 177108641
        • Dignam T
        • Kaufmann RB
        • LeStourgeon L
        • Brown MJ
        Control of lead sources in the United States, 1970-2017: public health progress and current challenges to eliminating lead exposure.
        J Public Health Manag Pract. 2019; 25: S13-S22
        • Pirkle JL
        • Brody DJ
        • Gunter EW
        • et al.
        The decline in blood lead levels in the United States. The National Health and Nutrition Examination Surveys (NHANES).
        JAMA. 1994; 272: 284-291
        • Tsoi MF
        • Cheung CL
        • Cheung TT
        • Cheung BM
        Continual decrease in blood lead level in Americans: United States National Health Nutrition and Examination Survey 1999-2014.
        Am J Med. 2016; 129: 1213-1218
        • Bellinger DC
        Very low lead exposures and children's neurodevelopment.
        Curr Opin Pediatr. 2008; 20: 172-177
        • Walker SP
        • Wachs TD
        • Grantham-McGregor S
        • et al.
        Inequality in early childhood: risk and protective factors for early child development.
        Lancet. 2011; 378: 1325-1338
        • Brody DJ
        • Pirkle JL
        • Kramer RA
        • et al.
        Blood lead levels in the U.S. population. Phase 1 of the third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1991) [published correction appears in JAMA. 1995;274(2):130].
        JAMA. 1994; 272: 277-283
        • Richter PA
        • Bishop EE
        • Wang J
        • Kaufmann R
        Trends in tobacco smoke exposure and blood lead levels among youths and adults in the United States: the National Health and Nutrition Examination Survey, 1999-2008.
        Prev Chronic Dis. 2013; 10: E213
        • Mann CJ
        Observational research methods. Research design II: cohort, cross sectional, and case-control studies.
        Emerg Med J. 2003; 20: 54-60
        • Harari F
        • Sallsten G
        • Christensson A
        • et al.
        Blood lead levels and decreased kidney function in a population-based cohort.
        Am J Kidney Dis. 2018; 72: 381-389
        • Jusko TA
        • Henderson CR
        • Lanphear BP
        • DA Cory-Slechta
        • Parsons PJ
        • Canfield RL
        Blood lead concentrations <10 microg/dL and child intelligence at 6 years of age.
        Environ Health Perspect. 2008; 116: 243-248
        • Mazumdar M
        • Bellinger DC
        • Gregas M
        • Abanilla K
        • Bacic J
        • Needleman HL
        Low-level environmental lead exposure in childhood and adult intellectual function: a follow-up study.
        Environ Health. 2011; 10: 24
        • Lanphear BP
        • Hornung R
        • Ho M
        • Howard CR
        • Eberly S
        • Knauf K
        Environmental lead exposure during early childhood [published correction appears in J Pediatr. 2002;140(4):490].
        J Pediatr. 2002; 140: 40-47
        • Zipf G
        • Chiappa M
        • Porter KS
        • Ostchega Y
        • Lewis BG
        • Dostal J.
        National Health and Nutrition Examination Survey: plan and operations, 1999-2010.
        Vital Health Stat 1. 2013; : 1-37
      1. Dorn HF, Cutler SJ, eds. Morbidity From Cancer in the United States. Washington, WA: United States Government Printing Office; 1959.

        • MacMahon B
        Birth-cohort analysis: a technique come of age.
        J Natl Cancer Inst. 1992; 84: 1386-1387
        • Ingram DD
        • Malec DJ
        • Makuc DM
        • et al.
        National Center for Health Statistics guidelines for analysis of trends.
        Vital Health Stat 2. 2018; : 1-71
        • Kim HJ
        • Fay MP
        • Feuer EJ
        • Midthune DN
        Permutation tests for joinpoint regression with applications to cancer rates [published correction appears in Stat Med. 2001;20(4):655].
        Stat Med. 2000; 19: 335-351<335::aid-sim336>;2-z
        • Ilic M
        • Ilic I
        Colorectal cancer mortality trends in Serbia during 1991-2010: an age-period-cohort analysis and a joinpoint regression analysis.
        Chin J Cancer. 2016; 35: 55
        • Jain RB
        Trends and variability in blood lead concentrations among U.S. children and adolescents.
        Environ Sci Pollut Res Int. 2016; 23: 7880-7889
        • Jones RL
        • Homa DM
        • Meyer PA
        • et al.
        Trends in blood lead levels and blood lead testing among U.S. children aged 1 to 5 years, 1988-2004.
        Pediatrics. 2009; 123: e376-e385
        • Raymond J
        • Brown MJ
        Blood lead levels in children aged <5 years - United States, 2007–2013.
        MMWR Morb Mortal Wkly Rep. 2016; 63: 66-72
      2. Integrated science assessment (ISA) for lead. United States Environment Protection Agency. Published 2003. Accessed June 30, 2020.

        • Haines DA
        • Saravanabhavan G
        • Werry K
        • Khoury C
        An overview of human biomonitoring of environmental chemicals in the Canadian Health Measures Survey: 2007-2019.
        Int J Hyg Environ Health. 2017; 220: 13-28
        • Becker K
        • Schroeter-Kermani C
        • Seiwert M
        • et al.
        German health-related environmental monitoring: assessing time trends of the general population's exposure to heavy metals.
        Int J Hyg Environ Health. 2013; 216: 250-254
        • Nisse C
        • Tagne-Fotso R
        • Howsam M
        • et al.
        Blood and urinary levels of metals and metalloids in the general adult population of Northern France: the IMEPOGE study, 2008-2010.
        Int J Hyg Environ Health. 2017; 220: 341-363
        • Seo JW
        • Kim BG
        • Kim YM
        • et al.
        Trend of blood lead, mercury, and cadmium levels in Korean population: data analysis of the Korea National Health and Nutrition Examination Survey.
        Environ Monit Assess. 2015; 187: 146
        • Nicolas C
        • Sylvain M
        • Come L
        • Jean F
        • Anne-Marie B
        • Valérie J
        Trends in gastric cancer incidence: a period and birth cohort analysis in a well-defined French population [published correction appears in Gastric Cancer. 2016;19(2):682].
        Gastric Cancer. 2016; 19: 508-514
      3. Health effects of low-level lead. National Toxicology Program, HHS. Published 2012. Accessed February 15, 2020.

        • Morrison D
        • Lin Q
        • Wiehe S
        • et al.
        Spatial relationships between lead sources and children's blood lead levels in the urban center of Indianapolis (USA).
        Environ Geochem Health. 2013; 35: 171-183
        • Woolf AD
        • Goldman R
        • Bellinger DC
        Update on the clinical management of childhood lead poisoning.
        Pediatr Clin North Am. 2007; 54 (viii): 271-294
        • Reuben A
        • Caspi A
        • Belsky DW
        • et al.
        Association of childhood blood lead levels with cognitive function and socioeconomic status at age 38 years and with IQ change and socioeconomic mobility between childhood and adulthood.
        JAMA. 2017; 317: 1244-1251
        • Barbosa Jr, F
        • Tanus-Santos JE
        • Gerlach RF
        • Parsons PJ.
        A critical review of biomarkers used for monitoring human exposure to lead: advantages, limitations, and future needs.
        Environ Health Perspect. 2005; 113: 1669-1674
        • Jedrychowski W
        • Perera FP
        • Jankowski J
        • et al.
        Very low prenatal exposure to lead and mental development of children in infancy and early childhood: Krakow prospective cohort study.
        Neuroepidemiology. 2009; 32: 270-278