Predicting blood lead concentrations from lead in environmental media.

Abstract

Policy statements providing health and environmental criteria for blood lead (PbB) often give recommendations on an acceptable distribution of PbB concentrations. Such statements may recommend distributions of PbB concentrations including an upper range (e.g., maximum and/or 90th percentile values) and central tendency (e.g., mean and/or 50th percentile) of the PbB distribution. Two major, and fundamentally dissimilar, methods to predict the distribution of PbB are currently in use: statistical analyses of epidemiologic data, and application of biokinetic models to environmental lead measurements to predict PbB. Although biokinetic models may include a parameter to predict contribution of lead from bone (PbBone), contemporary data based on chemical analyses of pediatric bone samples are rare. Dramatic decreases in environmental lead exposures over the past 15 years make questionable use of earlier data on PbBone concentrations to estimate a contribution of lead from bone; often used by physiologic modelers to predict PbB. X-ray fluorescent techniques estimating PbBone typically have an instrument-based quantitation limit that is too high for use with many young children. While these quantitation limits have improved during the late 1990s, PbBone estimates using an epidemiologic approach to describing these limits for general populations of children may generate values lower than the instrument's quantitation limit. Additional problems that occur if predicting PbB from environmental lead by biokinetic modeling include a) uncertainty regarding the fractional lead absorption by young children; b) questions of bioavailability of specific environmental sources of lead; and c) variability in fractional absorption values over a range of exposures. Additional sources of variability in lead exposures that affect predictions of PbB from models include differences in the prevalence of such child behaviors as intensity of hand-to-mouth activity and pica. In contrast with these sources of uncertainty and variability affecting physiologic modeling of PbB distributions, epidemiologic data reporting PbB values obtained by chemical analyses of blood samples avoid these problems but raise other issues about the validity of the representation of the subsample for the overall population of concern. State and local health department screening programs and/or medical evaluation of individual children provide PbB data that contribute to databases describing the impact of environmental sources on PbB. Overall, application of epidemiologic models involves fewer uncertainties and more readily reflects variability in PbB than does current state-of-the-art biokinetic modeling.