TABLE IV.
Rate Ratios by Cumulative Lead Exposure for Selected Underlying Causes of Death (1940–2013) in the Lead Smelter Cohort
| Cause of death | Cumulative lead exposure (mg/m3-days) | ||||||
|---|---|---|---|---|---|---|---|
|
| |||||||
| 0–<209 | 209–<757 | 757+ | Trend | ||||
|
| |||||||
| OBS | RR | OBS | RR (95%CI) | OBS | RR (95%CI) | P-value | |
| All causes | 578 | 1 (ref) | 576 | 1.02 (0.91, 1.14) | 595 | 1.14 (1.02, 1.28) | 0.02 |
| All cancersa | 149 | 1 (ref) | 130 | 1.05 (0.83, 1.33) | 108 | 0.99 (0.77, 1.27) | 0.90 |
| MN trachea, bronchus, lunga | 70 | 1 (ref) | 49 | 0.85 (0.59, 1.22) | 43 | 0.84 (0.58, 1.23) | 0.39 |
| MN stomacha | 11 | 1 (ref) | 5 | 0.65 (0.22, 1.91) | 3 | 0.44 (0.12, 1.61) | 0.21 |
| MN kidneya | 5 | 1 (ref) | 6 | 1.57 (0.48, 5.20) | 3 | 0.90 (0.21, 3.82) | 0.87 |
| Cardiovascular disease | 241 | 1 (ref) | 264 | 1.06 (0.89, 1.26) | 276 | 1.19 (1.00, 1.42) | 0.04 |
| Diseases of the heart | 178 | 1 (ref) | 198 | 1.08 (0.88, 1.32) | 203 | 1.20 (0.98, 1.46) | 0.08 |
| Ischemic heart disease | 151 | 1 (ref) | 156 | 1.02 (0.81, 1.27) | 165 | 1.16 (0.93, 1.45) | 0.17 |
| Hypertension with heart disease | 2 | 1 (ref) | 7 | 2.37 (0.48, 11.6) | 7 | 2.82 (0.58, 13.8) | 0.24 |
| Other diseases of the circulatory system | 63 | 1 (ref) | 67 | 1.00 (0.71, 1.41) | 73 | 1.19 (0.84, 1.67) | 0.28 |
| Hypertension without heart diseaseb | 32 | 1 (ref) | 25 | 0.84 (0.50, 1.42) | 25 | 0.93 (0.55, 1.58) | 0.84 |
| Cerebrovascular disease | 37 | 1 (ref) | 45 | 1.13 (0.73, 1.75) | 50 | 1.38 (0.90, 2.12) | 0.13 |
| Diseases of the respiratory system | 69 | 1 (ref) | 55 | 0.82 (0.57, 1.17) | 67 | 1.09 (0.78, 1.53) | 0.48 |
| Chronic obstructive pulmonary disease | 51 | 1 (ref) | 30 | 0.63 (0.40, 0.99) | 34 | 0.78 (0.51, 1.21) | 0.33 |
| Pneumoconiosis and other respiratory diseases | 7 | 1 (ref) | 9 | 1.14 (0.42, 3.09) | 11 | 1.54 (0.59, 4.02) | 0.35 |
| Diseases of the genitourinary system | 9 | 1 (ref) | 8 | 0.94 (0.36, 2.44) | 14 | 1.76 (0.76, 4.09) | 0.14 |
| Acute glomerulonephritis and renal failureb | 3 | 1 (ref) | 4 | 1.48 (0.33, 6.68) | 4 | 1.63 (0.36, 7.33) | 0.55 |
| Chronic and unspecified nephritis and renal failureb | 19 | 1 (ref) | 22 | 1.28 (0.69, 2.37) | 23 | 1.43 (0.78, 2.63) | 0.27 |
| Accidents | 39 | 1 (ref) | 27 | 0.87 (0.53, 1.42) | 40 | 1.39 (0.89, 2.17) | 0.11 |
| Transportation accidents | 18 | 1 (ref) | 13 | 0.96 (0.47, 1.98) | 18 | 1.42 (0.74, 2.76) | 0.26 |
| Accidental falls | 12 | 1 (ref) | 6 | 0.45 (0.17, 1.21) | 7 | 0.61 (0.24, 1.57) | 0.36 |
| Violence | 11 | 1 (ref) | 18 | 1.88 (0.88, 4.00) | 9 | 1.04 (0.43, 2.52) | 0.93 |
| Suicide | 10 | 1 (ref) | 17 | 1.97 (0.90, 4.32) | 9 | 1.14 (0.46, 2.82) | 0.93 |
OBS, observed deaths; RR, rate ratio (reference: <209 mg/m3-days of cumulative lead exposure); MN, malignant neoplasm; CI, confidence interval.
a
Cumulative exposure was lagged by10 years for cancer outcomes.
b
Results for hypertension without heart disease, acute glomerulonephritis and renal failure (AKD), and chronic and unspecified nephritis and renal failure (CKD) consider all causes listed on the death certificate (i.e., a multiple cause of death analysis).