Lead-Attributable Cardiovascular Disease Burden in North Africa and the Middle East: GBD 2023 Study

Chronic lead exposure contributes significantly to cardiovascular disease (CVD), yet its long-term impact in the North Africa and Middle East (NAME) region is not well described.

This study aimed to quantify trends in lead-attributable CVD burden in the NAME region from 1990 to 2023, examining mortality, morbidity, and variations by age, sex, and country.

We used Global Burden of Disease 2023 estimates to assess deaths, disability-adjusted life years (DALYs), years of life lost, and years lived with disability due to lead-attributable CVD in 21 NAME countries. Cardiovascular outcomes were modeled using the Cause of Death Ensemble Model and DisMod-MR 2.1. Lead exposure was estimated via spatiotemporal modeling of blood lead levels, and attributable burden was calculated using the Comparative Risk Assessment framework. Age-standardized rates were generated using the Global Burden of Disease world population.

Lead-attributable CVD deaths increased from 135,733 in 1990 to 306,630 in 2023, although the age-standardized death rate fell by 23.5%. DALYs more than doubled, rising from 3.27 million to 6.73 million, whereas the age-standardized DALY rate declined by 28.5%. Ischemic heart disease accounted for most of the burden. Male individuals consistently experienced higher rates than female individuals. Substantial heterogeneity existed across countries, with Egypt and Afghanistan showing the highest rates.

Despite declines in age-standardized CVD burden attributable to lead exposure, absolute numbers have increased markedly due to population growth and aging. Strengthening lead mitigation and cardiovascular prevention strategies is essential to reduce the future health burden in the NAME region.