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• W2019464511 abstract "Vol. 116, No. 3 PerspectivesOpen AccessRelationship between Tibia Lead and Cumulative Blood Lead Index: Schwartz et al. Respond Brian S. Schwartz Howard Hu Stephen J. Rothenberg Andrew C. Todd Brian S. Schwartz Search for more papers by this author , Howard Hu Search for more papers by this author , Stephen J. Rothenberg Search for more papers by this author , and Andrew C. Todd Search for more papers by this author Published:1 March 2008https://doi.org/10.1289/ehp.10778RCited by:4AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit We thank Healey et al. for their thoughtful comments on our papers in the mini-monograph on adult lead exposure (Hu et al. 2007; Schwartz and Hu 2007). We agree with the points they raised concerning uncertainties in the relation of cumulative blood lead index (CBLI) with tibia lead, the need to address the possibility that the slope of the relation may not be constant across the range of tibia lead values, and uncertainty about how sex may influence the relation, as most data were derived from studies of men. Given the changing metabolism of bone across the life span, age must ultimately be factored in as well.Healey et al. posit that the relation of CBLI with tibia lead may be nonlinear by presenting summary data from eight studies; they show that the estimated slope of the CBLI and tibia lead relation is relatively low in studies with lower mean tibia lead levels, whereas the estimated slope appears to be higher in studies with higher mean tibia lead levels. A problem with this argument is that it is prone to the ecologic fallacy of using summary data of CBLI and mean tibia lead from groups across studies to make inferences in individuals about the relation of CBLI with tibia lead. All of the literature evaluating relations of CBLI with tibia lead is based on measurements in only approximately 500 subjects. A rigorous assessment for possible nonlinearities in such a relation would require a pooled analysis of the original data, not an ecologic analysis of the summary results across studies (Lanphear et al. 1998). Several statistical techniques could then be used to evaluate possible departures from linearity in the CBLI versus tibia lead relation using the individual level data.Concerning the range of slopes we reported, we wrote “Each study also reported sample size and the SE of the slope, which, across the studies, ranged from 0.028 to 0.067” (Hu et al. 2007). Healey et al. correctly report that the slopes ranged from 0.022 to 0.10 μg/g per μg-years/dL across the eight studies they included. This discrepancy is easily explained. Concerning the high end of their range, we chose not to use the Armstrong et al. slope estimates for 1983 or 1988 (both 0.10, based on 15 and 11 subjects, respectively), instead relying on their estimate (0.052) for the 11 subjects for both 1983 and 1988 (Armstrong et al. 1992). Concerning the low end of their range (0.022), Gerhardsson et al. (1993) did not present an SE of the slope, which is needed, along with the slope estimate, for use in a meta-analysis.Given the ecologic fallacy issue discussed above, we respectfully disagree with the recommendation of Healey et al. that we should rely only on the two studies that reported the smallest slopes for the relation of CBLI with tibia lead (Gerhardsson 1993; Erkkilä 1992) simply because, as they note, these studies had average tibia lead levels closest to the 15 μg/g tibia lead limit we proposed (Schwartz and Hu 2007). In addition, we believe that relying on only two relatively small studies does not provide sufficient margin of safety for lead-exposed workers to accept Healey et al.’s recommendation at this time. Because our primary goal is preventing departures from health associated with cumulative lead dose in adults exposed to lead, we instead choose to rely on an estimate derived from a weighted mean across studies. At the present time, we believe we are justified in standing by our recommendation of a CBLI of 200–400 μg-years/dL.ReferencesArmstrong R, Chettle DR, Scott MC, Somervaille LJ, Pendlington M. 1992. Repeated measurements of tibia lead concentrations by in vivo X ray fluorescence in occupational exposure. Br J Ind Med 49(1):14-161733451. Medline, Google ScholarErkkilä J, Armstrong R, Riihimaki V, Chettle DR, Paakkari A, Scott Met al.. 1992. In vivo measurements of lead in bone at four anatomical sites: long term occupational and consequent endogenous exposure. Br J Ind Med 49(9):631-6441390269. Medline, Google ScholarGerhardsson L, Attewell R, Chettle DR, Englyst V, Lundstrom NG, Nordberg GFet al.. 1993. In vivo measurements of lead in bone in long-term exposed lead smelter workers. Arch Environ Health 48(3):147-1568333784. Crossref, Medline, Google ScholarHu H, Shih R, Rothenberg S, Schwartz BS. 2007. The epidemiology of lead toxicity in adults: measuring dose and consideration of other methodologic issues. Environ Health Perspect 115:455-46217431499. Link, Google ScholarLanphear BP, Matte TD, Rogers J, Clickner RP, Dietz B, Bornschein RLet al.. 1988. The contribution of lead-contaminated house dust and residential soil to children’s blood lead levels. A pooled analysis of 12 epidemiologic studies. Environ Res 79(1):51-689756680. Crossref, Medline, Google ScholarPopovic M, McNeill FE, Chettle DR, Webber CE, Lee CV, Kaye WE. 2005. Impact of occupational exposure on lead levels in women. Environ Health Perspect 113:478-48415811839. Link, Google ScholarSchwartz BS, Hu H. 2007. Adult lead exposure: time for change. Environ Health Perspect 115:451-45417431498. Link, Google ScholarFiguresReferencesRelatedDetailsCited By Dang X and Shan Z (2017) Dust pollution and control with leather waste, Environmental Chemistry Letters, 10.1007/s10311-017-0683-6, 16:2, (427-437), Online publication date: 1-Jun-2018. Lee M, Koutrakis P, Coull B, Kloog I and Schwartz J (2015) Acute effect of fine particulate matter on mortality in three Southeastern states from 2007–2011, Journal of Exposure Science & Environmental Epidemiology, 10.1038/jes.2015.47, 26:2, (173-179), Online publication date: 1-Mar-2016. Behinaein S, Chettle D, Egden L, McNeill F, Norman G, Richard N and Stever S (2012) Nonlinearity in the relationship between bone lead concentrations and CBLI for lead smelter employees, Journal of Environmental Monitoring, 10.1039/c2em30652b, 14:12, (3267), . CHETTLE D (2011) In vivo applications of X-ray fluorescence in human subjects, Pramana, 10.1007/s12043-011-0038-y, 76:2, (249-259), Online publication date: 1-Feb-2011. MacIntosh D, Minegishi T, Kaufman M, Baker B, Allen J, Levy J and Myatt T (2009) The benefits of whole-house in-duct air cleaning in reducing exposures to fine particulate matter of outdoor origin: A modeling analysis, Journal of Exposure Science & Environmental Epidemiology, 10.1038/jes.2009.16, 20:2, (213-224), Online publication date: 1-Mar-2010. Levy J, Greco S, Melly S and Mukhi N (2009) Evaluating Efficiency-Equality Tradeoffs for Mobile Source Control Strategies in an Urban Area, Risk Analysis, 10.1111/j.1539-6924.2008.01119.x, 29:1, (34-47), Online publication date: 1-Jan-2009. Puett R, Hart J, Yanosky J, Paciorek C, Schwartz J, Suh H, Speizer F and Laden F (2009) Chronic Fine and Coarse Particulate Exposure, Mortality, and Coronary Heart Disease in the Nurses’ Health Study, Environmental Health Perspectives, 117:11, (1697-1701), Online publication date: 1-Nov-2009. Vol. 116, No. 3 March 2008Metrics About Article Metrics Publication History Originally published1 March 2008Published in print1 March 2008 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days." @default.
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