A meta-analysis of blood lead levels in India and the attributable burden of disease

Bret Ericson*, Russell Dowling, Subhojit Dey, Jack Caravanos, Navya Mishra, Samantha Fisher, Myla Ramirez, Promila Sharma, Andrew McCartor, Pradeep Guin, Mark Patrick Taylor, Richard Fuller

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    13 Citations (Scopus)


    Multiple studies in India have found elevated blood lead levels (BLLs) in target populations. However the data have not yet been evaluated to understand population-wide exposure levels. We used arithmetic mean blood lead data published from 2010 to 2018 on Indian populations to calculate the average BLLs for multiple subgroups. We then calculated the attributable disease burden in IQ decrement and Disability Adjusted Life Years (DALYs). Our Pubmed search yielded 1066 articles. Of these, 31 studies representing the BLLs of 5472 people in 9 states met our study criteria. Evaluating these, we found a mean BLL of 6.86 μg/dL (95% CI: 4.38–9.35) in children and 7.52 μg/dL (95% CI: 5.28–9.76) in non-occupationally exposed adults. We calculated that these exposures resulted in 4.9 million DALYs (95% CI: 3.9–5.6) in the states we evaluated. Population-wide BLLs in India remain elevated despite regulatory action to eliminate leaded petrol, the most significant historical source. The estimated attributable disease burden is larger than previously calculated, particularly with regard to associated intellectual disability outcomes in children. Larger population-wide BLL studies are required to inform future calculations. Policy responses need to be developed to mitigate the worst exposures.

    Original languageEnglish
    Pages (from-to)461-470
    Number of pages10
    JournalEnvironment International
    Publication statusPublished - Dec 2018


    • Blood
    • Contamination
    • DALYs
    • India
    • Lead
    • Meta-analysis


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