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A cohort mortality study of lead-exposed workers in the USA, Finland and the UK
  1. Kyle Steenland1,
  2. Vaughn Barry1,
  3. Ahti Anttila2,
  4. Markku Sallmén3,
  5. Damien McElvenny4,
  6. AC Todd5,
  7. Kurt Straif6
  1. 1Rollins School PubHealth, Emory University, Atlanta, USA
  2. 2Finnish Cancer Registry, Helsinki, Finland
  3. 3Finnish Institute of Occupational Health, Work, Environment, Helsinki, Finland
  4. 4Insitute of Occupational Medicine, Edinburgh, UK
  5. 5Icahn School of Medicine at Mount Sinai, New York, USA
  6. 6International Agency for Research on Cancer (IARC), Lyon, France
  1. Correspondence to Dr Kyle Steenland, Rollins School PubHealth, Emory University, Atlanta 30322, USA; nsteenl{at}


Objectives To investigate further whether inorganic lead is a carcinogen among adults, or associated with increased blood pressure and kidney damage, via a large mortality study.

Methods We conducted internal analyses via Cox regression of mortality in three cohorts of lead-exposed workers with blood lead (BL) data (USA, Finland, UK), including over 88 000 workers and over 14 000 deaths. Our exposure metric was maximum BL. We also conducted external analyses using country-specific background rates.

Results The combined cohort had a median BL of 26 µg/dL, a mean first-year BL test of 1990 and was 96% male. Fifty per cent had more than one BL test (mean 7). Significant (p<0.05) positive trends, using the log of each worker’s maximum BL, were found for lung cancer, chronic obstructive pulmonary disease (COPD), stroke and heart disease, while borderline significant trends (0.05≤p≤0.10) were found for bladder cancer, brain cancer and larynx cancer. Most results were consistent across all three cohorts. In external comparisons, we found significantly elevated SMRs for those with BLs>40 µg/dL; for bladder, lung and larynx cancer; and for COPD. In a small subsample of the US cohort (n=115) who were interviewed, we found no association between smoking and BL.

Conclusions We found strong positive mortality trends, with increasing BL level, for several outcomes in internal analysis. Many of these outcomes are associated with smoking, for which we had no data. A borderline trend was found for brain cancer, not associated with smoking.

  • lead
  • cancer
  • occupation

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  • Contributors All contributors meet the criteria for authorship.

  • Funding Steenland worked on this project as part of his stay at IARC as a Visiting Scientist inthe summers of 2014 and 2015.

  • Competing interests None declared.

  • Ethics approval Emory University IRB: note, this is a record based study with no contact with study subjects.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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