Air Quality Criteria for Lead Volume II of II - (NEPIS)(EPA) - US ...

AX6-146
Table AX6-5.1 (cont’d). Effects of Lead on Blood Pressure and Hypertension
Reference, Study
Location, and
Period Study Description Pb Measurement Findings, Interpretation
Europe
Bost et al. (1999)
Europe-England-
Health Survey for
England
1995
2763 women and 2563 men from a multistage
stratified probability survey
representative of the English population
living in private residences, mean (SE) age
for men 47.5 yrs (0.34) and for women 47.7
yrs (0.33) (all subjects 16 yrs and older)
were used in an analysis of blood Pb
association with systolic and diastolic blood
pressure. Stepwise multiple regression
analysis were used testing natural log blood
Pb against common log systolic blood
pressure and non-transformed diastolic
blood pressure, with the following potential
covariates: age, BMI, smoking status,
region of residence, social class, and
alcohol consumption. Models were
stratified by sex, with and without
adjustment for alcohol, including or
excluding those taking antihypertensive
medications.
Geometric mean blood Pb:
Men: 3.7 µg/dL (no stated
measure of variance)
Women: 2.6 µg/dL
(no stated measure of
variance
Model tables presented only standardized variable coefficients. The most
consistent results were reported on common log Pb association with men’s
diastolic blood pressure. Every doubling of blood Pb was significantly
associated with an increase of 0.78 mm Hg (95% CI: 0.01, 1.55) diastolic
blood pressure, adjusted for age, log BMI, and alcohol, but excluding men
on antihypertensive medication. Every doubling of blood Pb was
significantly associated with an increase of 0.88 mm Hg (95% CI: 0.13,
1.63) in the same model with men on antihypertensive medication. Every
doubling of blood Pb was significantly associated with an increase of 0.96
mm Hg (95% CI: 0.23, 1.70) in the same model excluding men on
antihypertensive medication and not adjusting for alcohol. Every doubling
of blood Pb was significantly associated with an increase of 1.07 mm Hg
(95% CI: 0.37, 1.78) including men taking antihypertensive medication and
not accounting for alcohol. None of the multiple regression models had
significant Pb terms for women.
This report was not sufficiently detailed. Stepwise regression modeling is
prone to the usual pitfalls. Survey design adjusted analysis not used. Pb
was not entered in models in which criterion probability was exceeded
(p > 0.05). No rationale given for stratifying. No testing of differences
among Pb coefficients for the different models was made, which would have
been especially valuable to compare models adjusted and not adjusted for
alcohol use. No explanation for using log systolic blood pressure as
dependent variable. No model diagnostics reported.