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Medicine United States Science

Lead Exposure Kills Hundreds of Thousands of Adults Every Year in the US, Study Finds (theguardian.com) 220

Bruce66423 shares a report from The Guardian: Last week, a massive new study concluded that lead is 10 times more dangerous than thought, and that past exposure now hastens one in every five U.S. deaths. Researchers at four North American universities, led by Bruce Lanphear, of Simon Fraser University in Vancouver, studied the fate of 14,289 people whose blood had been tested in an official U.S. survey between 1988 and 1994. Four fifths of them had harbored levels of the toxic metal below what has, hitherto, been thought safe. The study found that deaths, especially from cardiovascular disease, increased markedly with exposure, even at the lowest levels. It concluded that lead kills 412,000 people a year -- accounting for 18% of all U.S. mortality, not much less than the 483,000 who perish as a result of smoking. The study has been published in the Lancet Public Health journal.
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Lead Exposure Kills Hundreds of Thousands of Adults Every Year in the US, Study Finds

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  • Lead kills (Score:4, Funny)

    by LordHighExecutioner ( 4245243 ) on Tuesday March 20, 2018 @06:03AM (#56289681)
    Especially when fired from a Smith&Wesson.
  • From the study:" .... An especially striking and unexpected finding in these studies is that the association between lead and disease is proportionately greater at lower levels of exposureâ"a so-called supralinear dose-response relation. ..."

    So what they're basically saying is that homeopathy might be right to a certain degree?

    Interesting. Interesting indeed.

    • by Megol ( 3135005 ) on Tuesday March 20, 2018 @06:40AM (#56289763)

      Not too interesting. Small doses give a higher response than a linear dose response would indicate, nothing more, nothing less. Magical water memory need not apply.

      • by DarkOx ( 621550 ) on Tuesday March 20, 2018 @06:50AM (#56289799) Journal

        Right but it does explain how people got by eating and drinking from leaded pewter dishes every day while slathering them selves in lead based make up; and how later people managed to be mostly okay breathing exhaust from leaded gasoline.

        It explains quite nicely how a small amount of lead can cause both serious problems and at the same time mass lead exposure did not destroy society. Although there is thinking that it impacted crime rates.

        • by nospam007 ( 722110 ) * on Tuesday March 20, 2018 @07:17AM (#56289861)

          "Right but it does explain how people got by eating and drinking from leaded pewter dishes every day while slathering them selves in lead based make up; "

          They died with the Roman Empire, some scientists even say, lead is the cause of both deaths.

          • "Right but it does explain how people got by eating and drinking from leaded pewter dishes every day while slathering them selves in lead based make up; " They died with the Roman Empire, some scientists even say, lead is the cause of both deaths.

            Hell, they used to EAT the stuff. Look up Sugar of Lead...

          • Re: (Score:3, Informative)

            by Anonymous Coward

            hey died with the Roman Empire, some scientists even say

            Crappy theory, originally spread by the germans, and already debunked multiple times. The Roman Empire ended because of the barbarian invasions, not lead exposure, otherwise it wouldn't have lasted for more than 500 years.

            • hey died with the Roman Empire, some scientists even say

              Crappy theory, originally spread by the germans, and already debunked multiple times. The Roman Empire ended because of the barbarian invasions, not lead exposure, otherwise it wouldn't have lasted for more than 500 years.

              More importantly, they outsourced their military to barbarians and then stopped paying them.

        • by Smidge204 ( 605297 ) on Tuesday March 20, 2018 @07:31AM (#56289893) Journal

          It explains quite nicely how a small amount of lead can cause both serious problems and at the same time mass lead exposure did not destroy society.

          Nothing of the sort.

          A small dose is proportionally more harmful than a larger dose, not more harmful in an absolute sense. Basically what the study says is double the dose does not result in double the damage.

          If you've been exposed to lead, exposing yourself to more lead will not improve your situation... so put down that paint smoothie.
          =Smidge=

          • by DarkOx ( 621550 )

            I am not suggesting lead exposure is good or that more lead exposure is better. The GGP was arguing that homeopathy works because small amounts of lead had impacts as significant as large ones.

            All I was saying is the fact that harm from lead exposure does not increase greatly with additional lead exposure helps explain why people got by "alright" when lead exposure at much higher levels was common. The point is after you have eaten a few chips the pain smoothie doesn't become good for you but its not as h

            • ... The GGP was arguing that homeopathy works because small amounts of lead had impacts as significant as large ones...

              Or, the GGGP was being facetious. Poe's law.

        • by nucrash ( 549705 ) on Tuesday March 20, 2018 @08:55AM (#56290159)

          The fact that for a long time so many societies had shorter lifespans seems to be irrelevant, doesn't it?

          Violent Crime dropped in the US after removing lead from gasoline. After research, we have found out how lead affects the chemistry in the brain. The link actually exists and the science backs it up. Lead does nasty things over a lifetime.

          • Correlation is not always causation. E.g., violent crime in the US has also dropped as the rate of gun ownership has gone up [huffingtonpost.com] over the same time period [aei.org]. Which one is it?
            • by Ed Tice ( 3732157 ) on Tuesday March 20, 2018 @01:10PM (#56291697)
              Although it's fun to say that correlation isn't causation, the research into lead and crime rates is both extensive and solid. It's relatively easy to remove confounding variables because different countries removed lead from gasoline at different times with a subsequent reduction in crime. And lots of studies have been done looking for alternative explanations without much luck. Also we have good knowledge of how lead affects the brain which supports the causal hypothesis.

              Gun ownership and crime is surely a very complex topic where the interaction between the two variables makes establishing a causal relationship much harder. I've lived in rural areas where there is no police force. Rates of gun ownership were a big crime deterrent. Of course so was that fact that people were poor so there was no point of robbing them.

              Urban crime rates are likely influenced more by the drug trade than overall gun ownership. The reality is that there are probably geographies where increased gun ownership results in lower crime and other geographies where it results in higher crime. Also, a property crime is less severe than a violent crime which also makes the problem harder.

              In the US we don't have good data in this area because the pro-gun lobby fights any effort to study the problem. The only motivation for such a thing is a fear of what the data will show. You don't want an answer to be found if you're pretty sure you're wrong! I'm pro gun-control but I could be persuaded by data if there were honest attempts and objective studies.

          • That's from an editorial in Mother Jones about 5 years back which made a big splash on the Internet, but didn't provide much evidence (mainly it just asserted the correlation was strong enough to be irrefutable).

            A perusal of recent research on the topic [google.com] turns up this recent JAMA paper [jamanetwork.com] which concluded that after controlling for childhood socioeconomic status, "Findings failed to support a dose-response association between BLL and consequential criminal offending." That would suggest that it's growing up
        • and at the same time mass lead exposure did not destroy society

          The effects of lead poisoning take a while to matieralise. Do you think it's a coincidence that we were huffing the stuff in the 80s and now the best OS we were able to come up with was Windows 10? Open your eyes!

    • by Opportunist ( 166417 ) on Tuesday March 20, 2018 @06:45AM (#56289783)

      That's not exactly what they say. What they say is that 1/10th of a dose does not have 1/10th of the effect, as would be expected, but way more than 1/10th.

      It's still a far cry from the homeopathetic claim that 1/10th of a dose has ten times the effect.

    • by houghi ( 78078 )

      Homeopathy might be completely right IF they can give scientific data that it is the case. Without the scientific data? Not so much.

      Also note that dosage is VERY important in intake of anything, be it medicine, poison or food. e.g. taking half the birth control pills will not just double your chances of getting pregnant.

  • How many people die ONLY because of lead exposure?

    How many people die ONLY because of smoking?

    How many people die ONLY because of diabetes?

    And so on and so forth. I'm more interested in the compound effects of multiple dangerous situations, eg. lead exposure AND smoking and so on.

    • Re:Overlap? (Score:5, Insightful)

      by cirby ( 2599 ) on Tuesday March 20, 2018 @07:07AM (#56289821)

      The study claims that nothing else had any measurable effect - once you filtered them out, the effect from lead was exactly the same. ...which does bring up a couple of small doubts. There are a number of things that SHOULD cause the amount of lead in your system to have an increased or decreased effect, at least on a detectable level.

      While it's reasonable that very small doses of lead will have a negative effect, I'd like to see some followup on this one. They say "it causes more deaths," but how much? Ten years off your lifespan? Ten days? Somewhere in between?

      It's in The Lancet, after all, and they have a bad habit of occasionally publishing something that's just flat wrong. Vaccines, anyone?

      • Re:Overlap? (Score:4, Interesting)

        by bobbied ( 2522392 ) on Tuesday March 20, 2018 @10:06AM (#56290535)

        It's in The Lancet, after all, and they have a bad habit of occasionally publishing something that's just flat wrong. Vaccines, anyone?

        I wouldn't call it a habit of the Lancet per say... Perhaps we should call it more of a profit center.

        Most medical journals have a perverse motive to increase circulation, attention by publishing studies that will bring them critical attention. In the case of the Lancet, they published a faked study about vaccines which they later retracted when it was shown to be faked years later by an investigative reporter. One questions their motives and lax editorial review processes because of things like this. But we really should realize that all of these publishers have the same perverse motives.

    • How many people die ONLY because of lead exposure?
      How many people die ONLY because of smoking?
      How many people die ONLY because of diabetes?

      I'm quite sure that living causes death.

      I haven't yet met anyone who has survived life.

      And remember . . . today is the last day of your life, so far . . .

    • by AHuxley ( 892839 )
      Lots of blood tests over decades.
      That would help find out if it was always only lead after say 2000.
      What can new survey data for lead show all over the USA now?
      Paint use has changed.
      Lots of other pollution and a poor diet its still not getting much support.
      Something in poor areas that saw a new drop in IQ and a list of illnesses.
      Thats a lot of lead paint chips and dust.
      A lot of productive lead mines still open in many city limits?
      Is lead getting worked on and with all over the USA in all very poor
  • Type 1 diabetes (Score:2, Interesting)

    by slazzy ( 864185 )
    Lead may be a trigger in autoimmune disorders such as type 1 diabetes as well.
    • Re:Type 1 diabetes (Score:5, Interesting)

      by Anonymous Coward on Tuesday March 20, 2018 @08:01AM (#56289971)

      No. So no that it's just scary.

      Type 1 diabetes means "requires insulin". No more, no less. The most common form of it is an auto-immune problem that destroys insulin producing cells. There is actually an effective treatment in testing at Mass. General Hospital, by Dr. Faustmann's lab, using the BCG vaccine in small doses to modify the white cell response and allow adult stem cells to transform into insulin producing cells. It's *very* exciting stuff.

      There is a great deal of immunological analysis and some biological testing that shows autoimmune Type 1 is triggered by infection, especially variants of the Coxsackie B flu virus. It's why some researchers have been trying to provide a diabetes vaccine. Part of the problem is that flu viruses mutate very quickly and very effictively, so even an effective vaccine wouldn't last long.

      Lead is a problem, but for pete's sake don't mix it up with other issues.

  • Unlikely (Score:4, Interesting)

    by 110010001000 ( 697113 ) on Tuesday March 20, 2018 @07:26AM (#56289879) Homepage Journal
    People at highest risk from cardiovascular disease are also at risk to exposure to lead. Lead based paint is still prevalent in some inner cities in older housing. Poor people live in this housing and die earlier than middle/upper income people. Poor people have a higher rate of cardiovascular disease. These studies are always so silly.
    • by Viol8 ( 599362 )

      Lead and its compounds are generally non volatile. There's about as much danger from lead in paint as there is from lead on a church roof. Unless you're stupid enough to lick it or eat it which admittedly some children can be.

      • Re: (Score:2, Insightful)

        Paint starts to flake, particularly by windows where sunlight comes in. Little kids sometimes sit by windows and look out and then suck their thumbs and ingest the lead. It is very common in the US. The kids aren't stupid, although you are ignorant.
      • by Gr8Apes ( 679165 )

        Paint deteriorates with time, flaking off and forming dust. I'm pretty sure that the leaded portion of paint is included in that dust. It's probably at greatest risk in poor housing where the lead paint is most likely to still be exposed to air.

        The leaded church roof won't form any meaningful dust but will leach minute levels of lead into rain that falls upon it, thus transferring lead to everywhere the roof's rainwater goes.

    • If only there were some mathematical apparatus that would allow us to analyze the behavior of a variable with respect to multiple other variables...
      • First you have to correctly identify the variables. They haven't. These studies come out all the time, and are false. They want to fund massive remediation programs.
    • Lead paint is common in _every_ house built before the mid 1970’s. If you look, you will find it. It is not just an inner city problem.

      • True, but it is a bigger problem in poor (a.k.a "inner city") areas because the maintenance isn't typically as high as non-poor areas, and housing is typically older. Lead paint isn't a problem until it starts to deteriorate.
    • People at highest risk from cardiovascular disease are also at risk to exposure to lead. Lead based paint is still prevalent in some inner cities in older housing. Poor people live in this housing and die earlier than middle/upper income people. Poor people have a higher rate of cardiovascular disease. These studies are always so silly.

      Ah yes I've seen your posts before. You come up with some reasons off the top of your head that would explain away the study's findings, and just assume that the practitioners didn't take any of that into account. It's arrogance in the highest degree.

    • From TFS:

      Lanphear and colleagues examined potential confounders and effect modifiers, including age, sex, ethnic origin, urban residence, smoking status, diabetes, hypertension, serum cholesterol, alcohol intake, and household income. They noted no appreciable attenuation of their estimates by any of these factors. The effect of lead on all-cause mortality and on cardiovascular disease mortality was greater in people younger than 50 years than in older adults, and it was significantly larger for non-smokers

    • I have no idea how this got modded to +5. Do you think that study authors really make no attempt to control for these variables? The studies aren't silly. At least not the vast majority of them. What you do is you take into account factors such as poverty and then you look to see if those factors explain the entirety of an effect. If not you have some evidence that the factor in question (in this case lead) is contributory. Now some studies suffer from trying to control so many factors that you questi
  • Similar tactics (Score:5, Interesting)

    by dargaud ( 518470 ) <slashdot2@NosPaM.gdargaud.net> on Tuesday March 20, 2018 @07:30AM (#56289889) Homepage
    It's interesting to note the lead has been known to be toxic since at least the time of the ancient greeks. And yet the paint industry used it as its main component for white paint until something like WWII. They used the same tactics that have been later used by Big Tobacco and climate change deniers to delay change by spreading fear, uncertainty and doubt. Particularly paying respected professionals (doctors, etc) to publish and deny toxicity.
    How do we know that ? When they were finally convicted, their archives were forced to become public and proved a treasure trove of assholery (or is that assholeness ?) There are several recent books and publications about that (namely in Scientific American)
    • Re: (Score:2, Insightful)

      by Anonymous Coward

      Its just a normal aspect of society. We reject bad news on things we are (in general) directly familiar with, like or find useful. Lead is extremely useful. We like(d) cigarettes. We like sugar in our food.

      And we will continue to be that way. I see people instantly reject studies that suggest marijuana in dangerous, or vaping. The people that most staunchly reject those studies tend to be the people that use those products. If we saw a study tomorrow that said potatoes were dangerous, the instant reaction w

      • Re:Similar tactics (Score:5, Interesting)

        by hey! ( 33014 ) on Tuesday March 20, 2018 @08:09AM (#56290001) Homepage Journal

        Actually, it's a conscious and deliberate choice by companies to exploit the natural tendency to be overly skeptical of change and overly accepting of the status quo. Yes, society is refractory when it comes to change, but it is not infinitely refractory. Without the calculated deceptions for companies profiting from the status quo, society would adapt to new information more quickly.

    • Well eating varnish isn't good for you either... and in addition to making vibrant colors, lead in paint also acted as a preservative. But still, you'd hope they wouldn't lie about it and just own up to that it was dangerous, explain the benefits, and how to use it safely. Certainly the sales reps don't try to convince us that lab chemicals are safe, we just get trained on how to avoid being injured by them.
    • Assholesomeness
    • by Luthair ( 847766 )
      Funny, I posted something very similar when this story was submitted and the submitter had included some bogus comment about how it was another instance of scientific experts being proven wrong :eyeroll:
    • ... [ redacted due to not being relevant to my smartassery ] ... How do we know that ? When they were finally convicted, their archives were forced to become public and proved a treasure trove of assholery (or is that assholeness ?) There are several recent books and publications about that (namely in Scientific American)

      "Assholeness" or "asshattery" are the accepted terms.

    • Lead was widely used as paint pigment in the US in residential housing until the 1970's. Special applications continued long after that.
       

  • From the dates that the blood samples were taken, 1988-1994, I would say that most people at that time had elevated lead levels from breathing all the leaded gas fumes for years previous. The mandate for catalytic converters went through in 1975 but, as I remember, it was into the 80's before all the leaded gas had stopped being available. I would bet that if that sampling were done now the levels would be much lower for most of the people sampled; at least the younger ones who were born after the switch to
    • by hey! ( 33014 ) on Tuesday March 20, 2018 @08:19AM (#56290033) Homepage Journal

      Many believe that tetraethyl lead is responsible for the rise in violent crime in the 70s and 80s, tracking the increase in cars and gasoline consumption in the post WW2 years. Likewise the drop in violent starting around 1990 was the effect of lead-free gas.

      Other than the availability of safe, legal abortions, it's about the only factor anyone's come up with that explains the prevalence of the violent crime trend across countries and legal jurisdictions with very different philosophies with respect to crime. In the US the reduction parallels an increase in gun sales, but the same trend occurs in countries where gun sales are flat or have gone down.

      • by Immerman ( 2627577 ) on Tuesday March 20, 2018 @09:09AM (#56290219)

        Quite. In fact I recall a study done analyzing violent crime rates around the world that found in every country violent crime started climbing ~20 years after the introduction of leaded gasoline, and began falling ~20 years after it was eliminated. Basically, if you grew up breathing lead fumes, you were more likely to commit violent crimes as an adult. The fact that every country introduced and banned leaded gasoline at different times helps to eliminate most other confounding factors that might have been responsible.

        Not at all surprising as a social observation, considering we know that on an individual level lead exposure in childhood tends to boost aggressiveness while reducing impulse control.

    • by sjames ( 1099 )

      Very probably, but since the effect was seen even at levels currently considered "safe", it still suggests that we may need to change what we consider "safe".

      In some places that were adjacent to heavy traffic, we may need to clean up the left over lead.

  • Oh crap... (Score:5, Interesting)

    by jenningsthecat ( 1525947 ) on Tuesday March 20, 2018 @08:09AM (#56290003)

    I guess that's the end of my cavalier attitude towards lead-based solder - now that I've been soldering for 50-plus years and still use my lips as a 'third hand' to hold solder sometimes. I know it's elemental lead and therefore less readily absorbed, but still... I've had my blood tested for lead levels a few times, and never had any results that caused my doctor even mild concern. But now that I've read this... It's probably too late for me, but from now on I won't be making any more snarky comments about "politically correct solder".

    Lead based solder performs much better than the alternatives, because lead is an 'aggressive' metal. I guess even the elemental form may be similarly aggressive when it comes to biochemical activity. Of course, this also renews my concerns about the mouthful of mercury I have in the form of dental fillings.

    • Your comment just reminded me of the two lead bars we had when I was a kid. They were ovals, with a company name and logo on the top side. Each one was about the size of a large bar of soap, but weighed 5 or 10 pounds. We would play with them sometimes, but only for a few minutes because of how heavy they were.

      • Fishing weight used to be made of lead... My grandpa would sometimes make some at home, melting the metal on a small gas burner. I remember playing with them quite a bit as a kid, they were exquisitely heady.

        Since I don't fish, I don't know what these are made of today ... Still lead?

        • Fishing weight used to be made of lead...

          And you had to bite them in order to make them open up before putting them on your line, and then bit them again to close them on the line. At least as a kid that's what I had to do, because I didn't have the finger strength.

        • Still lead. I still use my teeth to tighten them on the line. Oh well. I also make stained glass with lead solder, so I'm prolly gonna die.
        • At least here in Ontario, lead fishing sinkers are still available. I purchased some recently as weights for adjusting thread tensions on sewing machines.

          Your grandfather used lead to make sinkers. My dad used sinkers as a source of lead; he melted them down and poured the lead into the holes he had drilled in the head of one of his putters. He was tuning the balance so the club would be more accurate.

    • I have actually heard that lead based solder is environmentally better because it would lead (pun not intended) to less waste and contamination. The reasoning is that the eventual breakdown of tin based solder (whiskers, fractures, etc..) causes electronics to fail far more frequently and far sooner than they should otherwise, and so as a consequence instead of fixing it people will just throw their devices away and get another one and then meanwhile their old device will find its way into a dump site somew

      • Re:Oh crap... (Score:4, Interesting)

        by Megol ( 3135005 ) on Tuesday March 20, 2018 @11:04AM (#56290881)

        Short: conspiracy talk.

        Longer (TLDR?):
        Electronics doesn't die due to tin whiskers, the exempted areas that use leaded electronics (military, aviation, space, nuclear power plants, ...) are conservative and use what is known to work. Lead free solder require changes in soldering procedures which did cause problems previously (and in some cases still do) but whiskers aren't something commonly found in failed electronics.
        Most modern electronics die due to trends of everything having to be thin and light. That means we get electronics with smaller solder balls (shrinking BGAs with increasing number of connections), hotter temperatures and more varying temperatures (power management), devices more likely to suffer mechanical torture etc.

        Even if using leaded solder we'd have to use a number of different solders for different purposes and have the associated problems:
        One nice example being the Nvidia problem where BGA chips disconnected after some thermal cycling. While some claim the problem was in the underfill (material going around solder balls "gluing" the BGA chip itself to the substrate) it was often temporary fixed by trying to resolder the BGA chip in place. But the problematic chips used high-lead solder so it's not indicative of problems with lead free solders.
        Other similar problems like for the Xbox 360 have sometimes been blamed on lead free solder (no idea if that's correct) but as the above indicates this is something shared by modern electronics not matter which kind of solder is used.

        Also fashion/trends make people throw away perfectly good electronics long before they fail. I still have electronics produced with early lead free methods and they work exactly as they should - though that is of course just an anecdote rather than proof.

        • Interestingly, I haven't personally noticed problems with lead-free solder on SMT components - probably because most of the repair work I've done has been on lower-tech electronics where the parts and packages are larger and the connections are much less dense. My beef with lead-free has to do with through-hole components, especially those that carry higher currents and/or are subject to thermal cycling. I've seen quite a few such joints fail, even with plated holes, suitable hole sizes relative to the lead

  • by that's-so-kash ( 1561847 ) on Tuesday March 20, 2018 @09:48AM (#56290455)

    Even more garbage science.

    lead exposure doesn't lead to an increased death rate.

    people who live unhealthy lives, have higher exposures to lead. and tend to die of preventable diseases and have generally poor health.

    You may as well study a bad neighborhood and conclude that living in bad neighborhoods makes you poor.

    • yeah, it could not possibly be that the lead in the blood leads to poor health esp in our immune system, which then allows for regular bugs to kill us off. No, not that.
    • Could you point us to where your peer reviewed article is published rebutting this research? Because if you can't, you're just talking out your ass with nothing to back those words up.

    • The mods must be crazy. You're the second one to get modded-up today for such an uninsightful comment. Sorry but if you've ever *read* a study, the first thing that every author does is try to control for these variables and determine whether or not there is an additional effect. Now one fair criticism is that maybe the effect of lead is *less* than the other factors (I don't know). But there's not a single study out there that doesn't go through the process of controlling for known factors.
  • by WindBourne ( 631190 ) on Tuesday March 20, 2018 @10:57AM (#56290841) Journal
    Seriously, either cleaning up or shutting down coal plants is one of the smartest economical things that we did in a while.
    Even now, our lead on the ground is a fraction of what it was 10 years ago. As such, our children will have much lower medical costs than what we have today. The rest will be gone over the next 20 years, if not 10.
  • by blind biker ( 1066130 ) on Tuesday March 20, 2018 @11:05AM (#56290887) Journal

    Lead is but one of the heavy metals that coal fired plants spew into the environment, in massive amounts. Compared to them, nuclear plants are decidedly clean.

  • Substitute the word "Lead" with "Carrot" and see if it remains the same.

    If you test hard enough you can find tiny bits of anything in everything.

  • Ob (Score:4, Funny)

    by Hognoxious ( 631665 ) on Tuesday March 20, 2018 @11:45AM (#56291133) Homepage Journal

    Last week, a massive new study concluded that lead is 10 times more dangerous than thought

    There was this guy in my town who died of thought. He was an electrician and he thought he'd pulled the master fuse out.

  • "Thus, 14289 (76%) participants were included in this analysis. 1150 (9%) individuals had concentrations of lead in blood below the level of detection and had an amount of 07 g/dL (0034 mol/L) imputed."

    So, for 9% of those still alive whose Pb blood level was below the level of detection they "imputed" their Pb level at 0.7 micrograms per deciliter.

    "Our findings suggest that, of 23 million deaths every year in the USA, about 400000 are attributable to lead exposure, an estimate that is about ten times lar

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