Global burden of cardiovascular disease attributable to lead exposure: based on the global burden of disease study 2021.

Global age-standardized mortality and DALY rates for lead-attributable CVD declined from 1990 to 2021, but absolute burden remained high.

• EAPC was -0.76%/year for age-standardized mortality rate (ASMR) and -1.09%/year for age-standardized DALY rate (ASDR) from 1990 to 2021.
• Absolute burden in 2021 was approximately 1.48 million deaths and approximately 30.0 million DALYs.
• Higher absolute counts were observed in males compared to females.
• Data were extracted from GBD 2021 estimates covering the period 1990–2021.

Socioeconomic development level was associated with differential rates of burden reduction, with low-SDI regions experiencing increasing deaths and DALYs.

• High-SDI settings achieved the fastest rate reductions in ASMR and ASDR.
• Low-SDI regions experienced increasing deaths and DALYs over the study period.
• Low-SDI regions also showed slower declines in age-standardized rates compared to high-SDI regions.
• Frontier analysis identified large efficiency gaps in many low- and middle-SDI countries, suggesting these countries perform below what would be expected for their SDI level.

Population growth was the dominant driver of increasing lead-attributable CVD deaths and DALYs, partially offset by favorable epidemiologic change.

• Das Gupta-type decomposition was applied to separate effects of population growth, aging, and epidemiologic change.
• Population growth accounted for 96.07% of the increase in deaths and 131.44% of the increase in DALYs.
• Favorable epidemiologic change offset -43.19% of deaths and -78.83% of DALYs.
• Aging was also identified as a contributing driver alongside population growth.

Socioeconomic inequality in lead-attributable CVD burden widened between 1990 and 2021.

• The slope index of inequality (SII) for ASMR changed from -2.62 to -7.15 between 1990 and 2021, indicating widening absolute inequality.
• The SII for ASDR changed from -70.24 to -144.88 over the same period.
• Concentration indices became more negative from 1990 to 2021, indicating that burden became increasingly concentrated among lower-SDI populations.
• Inequality was assessed using both slope index of inequality and concentration index methods.

Projections using ARIMA models indicate continued declines in age-standardized rates of lead-attributable CVD through 2040.

• ARIMA models were used to project ASMR and ASDR to 2040.
• Both ASMR and ASDR are projected to continue declining through 2040.
• Despite projected rate declines, the authors note that absolute burden may remain substantial due to population growth and aging.
• Projections were based on GBD 2021 data spanning 1990–2021.

GBD 2021 data covering 1990–2021 were analyzed using multiple analytical approaches to characterize lead-attributable CVD burden.

• Outcomes included deaths, DALYs, and age-standardized rates (ASMR/ASDR) stratified by sex, SDI quintile, region, and country.
• Temporal trends were summarized using estimated annual percentage change (EAPC).
• Das Gupta-type decomposition was applied to separate population growth, aging, and epidemiologic change.
• Inequality was assessed using slope index of inequality (SII) and concentration index; efficiency gaps were evaluated via SDI-based frontier analysis using LOESS smoothing.