Front Public Health. 2026 Feb 27;14:1690287. doi: 10.3389/fpubh.2026.1690287. eCollection 2026.
ABSTRACT
BACKGROUND: Lead exposure is an important but under-recognized environmental contributor to cardiovascular disease (CVD). Using GBD 2021, we quantified long-term trends, socioeconomic inequalities, key drivers, prevention potential, and future trajectories of lead-attributable CVD burden.
METHODS: We extracted GBD 2021 estimates (1990-2021) for deaths, DALYs, and age-standardized rates (ASMR/ASDR) by sex, SDI quintile, region, and country. Temporal trends were summarized using estimated annual percentage change. We applied Das Gupta-type decomposition (population growth, aging, epidemiologic change), assessed inequality using slope index of inequality and concentration index, evaluated efficiency gaps via SDI-based frontier (LOESS), and projected ASMR/ASDR to 2040 using ARIMA models.
RESULTS: Globally, ASMR and ASDR declined from 1990 to 2021 (EAPC -0.76%/year for ASMR; -1.09%/year for ASDR), yet the absolute burden remained high in 2021 (≈1.48 million deaths; ≈30.0 million DALYs), with higher counts in males. High-SDI settings achieved the fastest rate reductions, whereas low-SDI regions experienced increasing deaths/DALYs and slower declines. Decomposition showed population growth was the dominant driver of increasing deaths (96.07%) and DALYs (131.44%), partially offset by favorable epidemiologic change (-43.19% deaths; -78.83% DALYs). Inequality widened from 1990 to 2021 (ASMR SII - 2.62 to -7.15; ASDR SII - 70.24 to -144.88; concentration indices became more negative). Frontier analysis identified large efficiency gaps in many low- and middle-SDI countries. Projections suggest continued declines in age-standardized rates to 2040.
CONCLUSION: Despite falling age-standardized rates, lead-attributable CVD burden remains substantial and increasingly concentrated in lower-SDI populations, driven mainly by population growth and aging. SDI-stratified policies combining lead source control with scalable CVD prevention are essential to reduce inequities and close efficiency gaps.
PMID:41835416 | PMC:PMC12982341 | DOI:10.3389/fpubh.2026.1690287