Global burden of cardiovascular disease attributable to lead exposure: based on the global burden of disease study 2021

TL;DR

This study shows that lead exposure still causes significant heart disease globally, especially in poorer regions, despite some improvements over time.

Contribution

The study provides new global trends and projections of cardiovascular disease burden attributable to lead exposure using GBD 2021 data.

Findings

Age-standardized rates of lead-attributable CVD declined globally from 1990 to 2021, but absolute burden remained high.

Low-SDI regions experienced increasing deaths and slower declines in CVD burden compared to high-SDI regions.

Population growth was the main driver of increased CVD burden, partially offset by epidemiologic improvements.

Abstract

Lead exposure is an important but under-recognized environmental contributor to cardiovascular disease (CVD). Using GBD 2021, we quantified long-term trends, socioeconomic inequalities, key drivers, prevention potential, and future trajectories of lead-attributable CVD burden.

We extracted GBD 2021 estimates (1990–2021) for deaths, DALYs, and age-standardized rates (ASMR/ASDR) by sex, SDI quintile, region, and country. Temporal trends were summarized using estimated annual percentage change. We applied Das Gupta–type decomposition (population growth, aging, epidemiologic change), assessed inequality using slope index of inequality and concentration index, evaluated efficiency gaps via SDI-based frontier (LOESS), and projected ASMR/ASDR to 2040 using ARIMA models.

Globally, ASMR and ASDR declined from 1990 to 2021 (EAPC −0.76%/year for ASMR; −1.09%/year for ASDR), yet the absolute burden remained high in 2021 (≈1.48 million deaths; ≈30.0 million DALYs), with higher counts in males. High-SDI settings achieved the fastest rate reductions, whereas low-SDI regions experienced increasing deaths/DALYs and slower declines. Decomposition showed population growth was the dominant driver of increasing deaths (96.07%) and DALYs (131.44%), partially offset by favorable epidemiologic change (−43.19% deaths; −78.83% DALYs). Inequality widened from 1990 to 2021 (ASMR SII − 2.62 to −7.15; ASDR SII − 70.24 to −144.88; concentration indices became more negative). Frontier analysis identified large efficiency gaps in many low- and middle-SDI countries. Projections suggest continued declines in age-standardized rates to 2040.

Despite falling age-standardized rates, lead-attributable CVD burden remains substantial and increasingly concentrated in lower-SDI populations, driven mainly by population growth and aging. SDI-stratified policies combining lead source control with scalable CVD prevention are essential to reduce inequities and close efficiency gaps.

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