Burden of cardiovascular disease attributable to dietary lead exposure among adults in China, 2017
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摘要:
目的 分析中国2017年成人膳食来源铅暴露所致心血管疾病(CVD)的疾病负担,为评估食品中铅暴露导致的健康危害提供参考依据。 方法 收集2000年1月 — 2020年7月万方数据知识服务平台、中国知网数据库、中国生物医学文献数据库、PubMed数据库和Web of Science数据库中公开发表的关于中国成人血铅的相关文献,2017年全球疾病负担研究(GBD 2017)中2017年CVD的疾病负担数据以及食物、空气、饮用水的铅浓度和经消化道、呼吸道摄入铅的生物利用度相关数据,采用比较风险评估法计算人群归因分值(PAF)估算铅暴露导致CVD的疾病负担,并参考整合暴露吸收生物动力学模型(IEUBK)的原理计算膳食铅暴露途径对血铅的贡献率。 结果 中国成人血铅水平为5.23 μg/dL,男性和女性成人血铅水平分别为5.96 和4.90 μg/dL;2017年中国成人由于铅暴露导致CVD的疾病负担为323.96万人年,四川省、云南省和湖南省的总CVD标化归因DALY率较高,每10万人中分别可造成635.00、633.62和547.36个健康寿命年的损失;膳食是铅暴露的主要途径,对男性和女性成人的贡献率分别为57.01 %和58.60 %,导致CVD的总DALYs为186.34万人年,包括缺血性心脏病60.23万人年、脑卒中99.70万人年和高血压心脏病19.37万人年。 结论 铅暴露对中国成人造成了较大的CVD疾病负担,其中膳食途径是铅暴露的主要来源。 Abstract:Objective To analyze the burden of cardiovascular disease (CVD) attributable to dietary lead among Chinese adults aged 18 years and over in 2017, and to provide a reference for assessing health hazards caused by exposure to lead in diet. Methods The data on disease burden of CVD among residents in China were extracted from the Global Burden of Disease Study 2017 (GBD 2017). The information relevant to blood lead (BLL), bioavailability of lead ingestion through digestive tract and respiratory tract for Chinese adults and lead concentrations in food, air, and drinking water were retrieved form literatures published from January 2000 to July 2020 via searching PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, and China Biology Medicine Database (CBMdisc). Population attribution fraction (PAF) was calculated using comparative risk assessment to estimate the burden of cardiovascular disease due to lead exposure. Based on the principle of integrated exposure uptake biokinetic (IEUBK) model, the contribution rate of dietary lead exposure to BLL was evaluated. Results The pooled mean BLL for Chinese adults was 5.23 μg/dL (5.96 μg/dL for males and 4.90 μg/dL for females). In 2017, the total disability-adjusted life years (DALYs) of cardiovascular disease attributable to lead exposure in Chinese adults was 3.2396 million years and the standardized attributable DALY rate was high for the adults in Sichuan, Yunnan, and Hunan province, resulting in the loss of 635.00, 633.62, and 547.36 healthy life years per 100 000 people, respectively. The dietary lead was a major contributor to the adults′ lead exposure, accounting for 57.01% and 58.60% of total lead exposure in male and female adults. The DALYs of cardiovascular disease attributed to dietary lead exposure was 1.8634 million, including 602.3 thousand DALYs of ischemic heart disease, 997.0 thousand DALYs of stroke, and 193.7 thousand DALYs of hypertensive heart disease. Conclusion For Chinese adults in 2017, lead exposure contributes to a significant ratio of burden of cardiovascular disease, and diet is a primary source of lead exposure. -
Key words:
- lead exposure /
- cardiovascular disease /
- disease burden /
- dietary source /
- adults /
- China
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表 1 中国各省(自治区、直辖市)成人的血铅水平(μg/dL)
行政区 样本量 几何均值(μg/dL) 几何标准差(μg/dL) 北京市 1167 4.87 2.89 天津市 25 4.78 1.41 陕西省 40 6.37 3.97 辽宁省 1222 4.08 3.93 吉林省 453 3.03 3.20 黑龙江省 892 6.72 NR a 上海市 36 8.95 4.66 江苏省 260 7.15 3.09 浙江省 976 6.81 4.57 安徽省 1098 2.88 3.75 山东省 312 8.13 5.79 河南省 2209 5.49 3.77 湖北省 1048 4.39 6.22 湖南省 2120 7.89 3.13 广东省 109 5.10 0.75 广西壮族自治区 65 9.86 2.41 重庆市 1486 7.73 2.74 四川省 83 7.61 4.77 贵州省 157 7.44 0.98 云南省 233 8.29 6.70 注:a NR表示文献中未报道。 表 2 中国2017年成人铅暴露所致CVD的PAF和疾病负担
行政区 缺血性心脏病 脑卒中 高血压心脏病 总CVD PAF DALY
(万人年)DALY率
(1/10万)PAF DALY
(万人年)DALY率
(1/10万)PAF DALY
(万人年)DALY率
(1/10万)DALY
(万人年)DALY率
(1/10万)北京市 2.71 0.91 53.11 3.05 1.26 73.31 5.45 0.09 5.17 2.37 138.20 天津市 0.92 0.37 30.23 1.04 0.49 40.12 1.83 0.02 1.74 0.92 74.29 陕西省 4.04 3.39 115.90 4.54 5.04 172.23 8.05 0.78 26.51 9.57 326.85 辽宁省 2.82 4.68 135.41 3.17 6.63 191.96 5.67 0.39 11.19 12.03 348.29 吉林省 1.71 1.63 75.67 1.93 2.11 98.04 3.47 0.31 14.34 4.16 193.61 上海市 5.13 1.20 62.54 5.77 2.17 113.67 10.14 0.22 11.35 3.84 200.99 江苏省 4.09 4.17 65.73 4.60 10.49 165.18 8.14 1.59 25.11 16.94 266.85 浙江省 4.37 2.07 46.22 4.91 5.41 120.84 8.70 1.35 30.13 9.30 208.00 安徽省 1.94 2.29 46.25 2.18 4.48 90.54 3.93 1.01 20.41 8.04 162.55 山东省 4.97 13.83 174.74 5.59 17.83 225.32 9.85 2.63 33.24 35.41 539.39 河南省 3.54 9.95 131.65 3.98 15.62 206.63 7.09 2.08 27.47 28.34 358.14 湖北省 3.63 4.54 97.20 4.08 8.86 189.91 7.28 2.18 46.63 16.10 213.02 湖南省 4.45 8.01 147.66 5.00 11.70 215.73 8.82 4.77 87.99 25.55 547.36 广东省 1.55 2.55 28.86 1.75 3.41 38.59 3.10 0.63 7.09 6.87 242.84 广西壮族自治区 5.08 5.00 129.56 5.70 8.49 219.81 9.99 1.78 46.02 16.10 296.87 重庆市 4.23 1.75 72.08 4.76 3.77 154.96 8.40 0.86 35.22 6.74 76.26 四川省 4.70 6.44 98.17 5.29 14.49 220.68 9.33 2.35 35.83 24.53 635.00 贵州省 4.00 2.15 76.11 4.50 6.35 224.22 7.95 0.81 28.66 9.83 258.96 云南省 5.10 4.41 116.29 5.73 8.60 226.59 10.10 1.57 41.25 15.41 633.62 表 3 中国2017年成人膳食来源铅暴露所致CVD的疾病负担
暴露途径 性别 缺血性心脏病 脑卒中 高血压心脏病 总CVD DALY
(万人年)DALY率
(1/10万)DALY
(万人年)DALY率
(1/10万)DALY
(万人年)DALY率
(1/10万)DALY
(万人年)DALY率
(1/10万)食物 男性 40.63 72.23 67.25 119.57 13.06 23.22 125.69 223.46 女性 19.60 36.52 32.45 60.46 6.31 11.76 60.66 113.01 合计 60.23 108.76 99.70 180.03 19.37 34.97 186.34 336.48 空气 男性 30.48 54.19 50.45 89.70 9.80 17.42 94.29 167.65 女性 13.77 25.66 22.80 42.48 4.43 8.26 42.62 79.41 合计 44.25 79.85 73.26 132.19 14.23 25.68 136.91 247.06 饮用水 男性 0.15 0.27 0.25 0.45 0.05 0.09 0.47 0.84 女性 0.07 0.14 0.12 0.23 0.02 0.04 0.23 0.42 合计 0.23 0.41 0.37 0.68 0.07 0.13 0.70 1.26 合计 男性 71.26 126.70 117.96 209.72 22.90 40.72 220.45 391.95 女性 33.45 62.32 55.38 103.17 10.77 20.06 103.50 192.84 合计 104.71 95.26 173.33 157.69 33.67 30.63 323.96 294.73 -
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