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

AX6-161
Table AX6-5.2 (cont’d). Effects of Lead on Cardiovascular Morbidity
Reference, Study
Location, and
Period Study Description Pb Measurement Findings, Interpretation
United States (cont’d)
Tepper et al.
(2001)
U.S.-Cincinnati,
OH
After 1991 to
before 2001
Europe
Gustavsson et al.
(2001)
Europe-
Stockholm,
Sweden
1992-1994
See Tepper et al. (2001) entry in Blood
Pressure and Hypertension for left
ventricular mass results.
Study base was all Swedish citizens
45-70 yrs old from Stockholm County
free of previous myocardial infarction.
Cases who survived at least 28 days
after infarct (1,105 males and 538
females) of which 937 men (85%) and
398 women (74%) had sufficient
information on occupational exposures
and “main confounders”, were
compared against referents (1,120 men
and 538 women) matched to cases by
sex, age, yr, and hospital catchment
area. Risk ratios for the case group
compared to referent group were
adjusted on the basis of the matching
variables and smoking, alcohol
drinking, hypertension, overweight,
diabetes mellitus, leisure physical
“inactivity”, and were calculated for a
number of exposure factors separately,
including Pb.
Pb exposure was
classified as none, low or
high corresponding to
airborne dust levels of 0,
>0 to 0.03, and
∃0.04 mg/m 3 ,
respectively, for the
highest intensity of
exposure during at least
one yr of work. The same
three classifications were
used for 0, >0 to 0.04, and
∃0.05 mg/m 3 for
cumulative exposure.
All risk ratios were calculated relative to the “no exposure” groups. Adjusted
risk ratios for surviving a myocardial infarction were 0.88 (95% CI: 0.69, 1.12)
and 1.03 (95% CI: 0.64, 1.65) for low and high exposure groups for peak Pb
exposure, and were 0.81 (95% CI: 0.60, 1.11) and 1.00 (0.74, 1.34) for the low
and high cumulative exposure groups.
This study of myocardial morbidity was compromised by poor Pb exposure
characterization (occupational air dust Pb concentration) and by including a
covariate collinear with Pb exposure and confounded with the outcome,
hypertension, in the adjusted models.
No model diagnostics were reported.