Nonoccupational determinants of blood lead concentrations in a general population

We investigated the influence of various nonoccupational factors on blood lead levels (PbB) in a sample from the general population of southern Germany. Some 1703 men and 1661 women, aged 28-67 years, were examined in the first follow-up examination of the MONICA Augsburg cohort study in 1987-1988. Their mean PbB was 90 micrograms/l (SD:35.9) for men and 65 micrograms/l (26.4) for women. Only 5% of the men and 1% of all women exceeded a PbB level of 150 micrograms/l indicating low-level lead exposure in this population. Blood lead was significantly associated with haematocrit values (P < 0.001) and the shape of this association was curvilinear. Per gram of alcohol consumed, intake of beer had a lower impact on PbB than wine, presumably due to differential lead content in these alcoholic beverages. The alcohol-PbB associations were stronger for women than for men. The impact of smoking was generally moderate but again more prominent in women. In particular, the covariate adjusted odds ratios for women of childbearing age (28-47 years) to have PbB levels above 100 micrograms/l were 2.5 (95% confidence interval (CI): 1.3-4.7) for smoking versus non-smoking females, 2.6 (95% CI: 1.1-6.0) for women drinking up to 40 g alcohol/day compared to abstainers, and 8.9 (95% CI: 3.2-25.1) for those drinking more than 40 g alcohol/day. Other factors like age, body mass, rural place of residence, and education or job position, had only minor influences on PbB. We conclude that haematocrit values should always be considered as potential confounders in low-level lead exposure research. High alcohol consumption and cigarette smoking are strongly related to elevated blood lead concentrations in the general population and may thereby convey additional health hazards such as impaired child development or blood pressure elevations. This deserves proper public health recognition [corrected].