Despite regulatory actions, lead (Pb) exposure remains a major environmental health concern worldwide due to its widespread occurrence and potential adverse effects. The aims of this study were to explore internal Pb exposure in EU citizens, identify its main sociodemographic determinants, and investigate temporal variations over the last decades. Blood Pb data from a total of 17,790 individuals from 9 biomonitoring studies conducted between 2003 and 2019 in four European countries [Belgium (FLEHS I-IV), teenagers and adults; Czech Republic (SZU), children and adults; Spain (BIOAMBIENT.ES), adults; Germany (ESB, GerES IV and V), with all three age groups] were used. The European Human Biomonitoring Initiative (HBM4EU) harmonized and integrated the different datasets. Linear mixed-model analyses were performed to explore exposure determinants related to Pb concentrations. All participants showed detectable blood Pb concentrations, with an overall mean concentration (± standard deviation) of 20.6 (± 16.7) µg/L. In multivariable analyses, older age at recruitment, smoking habit and residence in more urbanized areas were associated with higher Pb levels, whereas more recent sampling year and higher educational level with lower concentrations. After pooled analysis of individual data, no significant differences were found in the Pb levels of the European citizens studied, probably due to the heterogeneity of the studies included. Collaborative efforts between public health agencies, environmental regulators and communities must continue to monitor trends, explore emerging sources of exposure and refine strategies to ensure sustained progress in reducing Pb levels and protecting the health of European population.

Analytical Environmental and Geo Chemistry Department Vrije Universiteit Brussel Brussels Belgium

Biomedical Research Center Department of Radiology and Physical Medicine Medical School University of Granada Granada Spain

Centre for Health and Environment National Institute of Public Health Prague Czech Republic

CIBER de Epidemiología y Salud Pública Madrid Spain

Department of Biomedical Sciences University of Antwerp Antwerp 2610 Belgium

Department of Preventive Medicine and Public Health Pharmacy School Universidad de Granada Granada Spain

Environmental Toxicology Unit National Centre for Environmental Health Instituto de Salud Carlos 3 Madrid Spain

German Environment Agency Corrensplatz 1 14195 Berlin Germany

Instituto de Investigación Biosanitaria de Granada Granada Spain

National Center for Public Health and Pharmacy Albert Flórián út 2 6 Budapest 1097 Hungary

Provincial Institute of Hygiene Antwerp Belgium

School of Medicine University of Granada Av del Conocimiento 19 Granada 18016 Spain

Unidad de Gestión Clínica de Laboratorios Hospital Universitario San Cecilio Granada Spain

VITO Health Flemish Institute for Technological Research Mol Belgium

Zobrazit více v PubMed

Can, S. et al. Occupational lead exposure effect on liver functions and biochemical parameters. PubMed

Harari, F. et al. Blood lead levels and decreased kidney function in a population-based cohort. PubMed

Lanphear, B. P., Rauch, S., Auinger, P., Allen, R. W. & Hornung, R. W. Low-level lead exposure and mortality in US adults: a population-based cohort study. PubMed

Obeng-Gyasi, E., Ferguson, A. C., Stamatakis, K. A. & Province, M. A. Combined effect of lead exposure and allostatic load on cardiovascular disease mortality. A preliminary study. PubMed PMC

Wan, H. et al. Chronic lead exposure induces fatty liver disease associated with the variations of gut microbiota. PubMed

Rosengren, E. et al. Exposure to lead and coronary artery atherosclerosis: A Swedish cross-sectional population-based study. PubMed PMC

Dietert, R. R., Lee, J. E., Hussain, I. & Piepenbrink, M. Developmental immunotoxicology of lead. PubMed

Dimitrov, L. V. et al. A systematic review and meta-analysis of chemical exposures and attention-deficit/hyperactivity disorder in children. PubMed PMC

EFSA. Scientific opinion on lead in food.

Menezes-Filho, J. A. et al. C. S., et al. Environmental co-exposure to lead and manganese and intellectual deficit in school-aged children. PubMed PMC

Téllez-Rojo, M. M. et al. Longitudinal associations between blood lead concentrations lower than 10 microg/dl and neurobehavioral development in environmentally exposed children in Mexico City. PubMed

Chang, S. H. et al. Low blood lead concentration in association with infertility in women. PubMed

Choe, S. Y. et al. Evaluation of estrogenicity of major heavy metals. PubMed

Darbre, P. D. Metalloestrogens: an emerging class of inorganic xenoestrogens with potential to add to the oestrogenic burden of the human breast. PubMed

Martin, M. B. et al. Estrogen-like activity of metals in MCF-7 breast cancer cells. PubMed

Swarup, D. et al. Changes in plasma hormones profile and liver function in cows naturally exposed to lead and cadmium around different industrial areas. PubMed

IARC. Monographs on the evaluation of carcinogenic risks to humans. Inorganic and organic Lead compounds, Volume 87. (2006). https://publications.iarc.who.int/_publications/media/download/2742/4c6e963acd7ad3b767d0720848796ef7099dd02a.pdf PubMed PMC

Lamas, G. A. et al. Contaminant metals as cardiovascular risk factors: A scientific statement from the American heart association. PubMed PMC

Ou, Y. et al. Associations between toxic and essential trace elements in maternal blood and fetal congenital heart defects. PubMed

Gundacker, C. et al. Lead (Pb) and neurodevelopment: A review on exposure and biomarkers of effect (BDNF, HDL) and susceptibility. PubMed

Freire, C. et al. Prenatal co-exposure to neurotoxic metals and neurodevelopment in preschool children: the environment and childhood (INMA) project. PubMed

WHO. Exposure to Lead: a major public health concern, 3rd edition. (2023). https://www.who.int/publications/i/item/9789240078130

Apostoli, P. et al. Blood lead reference values: the results of an Italian polycentric study. PubMed

Cerná, M., Krsková, A., Cejchanová, M. & Spěváčková, V. Human biomonitoring in the Czech republic: an overview. PubMed

Falq, G. et al. Blood lead levels in the adult population living in France the French nutrition and health survey (ENNS 2006–2007). PubMed

Galal-Gorchev, H. Dietary intake, levels in food and estimated intake of lead, cadmium, and mercury. PubMed

EFSA. Lead dietary exposure in the European population.

ECHA. (2023). https://echa.europa.eu/es/-/echa-recommends-eight-substances-for-reach-authorisation

FSCJ-Food Safety Commission of Japan. Lead (chemicals and contaminants). PubMed PMC

Jeong, K. S. et al. Evidence that cognitive deficit in children is associated not only with iron deficiency, but also with blood lead concentration: a preliminary study. PubMed

Pawlas, N. et al. Modification by the genes ALAD and VDR of lead-induced cognitive effects in children. PubMed

Wilhelm, M., Heinzow, B., Angerer, J. & Schulz, C. Reassessment of critical lead effects by the German human biomonitoring commission results in suspension of the human biomonitoring values (HBM I and HBM II) for lead in blood of children and adults. PubMed

Cañas, A. I. et al. Blood lead levels in a representative sample of the Spanish adult population: the BIOAMBIENT. ES project. PubMed

Lermen, D. et al. Long-term time trend of lead exposure in young German adults - Evaluation of more than 35 years of data of the German environmental specimen bank. PubMed

Schoeters, G. et al. Internal exposure of Flemish teenagers to environmental pollutants: results of the Flemish environment and health study 2016–2020 (FLEHS IV). PubMed

Schroijen, C. et al. Internal exposure to pollutants measured in blood and urine of Flemish adolescents in function of area of residence. PubMed

Vogel, N. et al. Lead, cadmium, mercury, and chromium in urine and blood of children and adolescents in Germany - Human biomonitoring results of the German environmental survey 2014–2017 (GerES V). PubMed

Rosofsky, A. et al. Exposure to multiple chemicals in a cohort of reproductive-aged Danish women. PubMed PMC

Schoeters, G. et al. Three cycles of human biomonitoring in Flanders – Time trends observed in the Flemish environment and health study. PubMed

Ramírez Ortega, D. et al. J., et al. Cognitive impairment induced by lead exposure during lifespan: mechanisms of lead neurotoxicity. PubMed PMC

Yan, Y. Z., Hu, Y. H., Guo, H. & Lin, K. Q. Burden of cardiovascular disease attributable to dietary lead exposure in adolescents and adults in China. PubMed

Directive, E. U. 98/70/EC, relating to the quality of petrol and diesel fuels. https://eur-lex.europa.eu/resource.html?uri=cellar:9cdbfc9b-d814-4e9e-b05d-49dbb7c97ba1.0008.02/DOC_1&format=PDF

Cerná, M. et al. Human biomonitoring system in the Czech Republic. PubMed

Kim, N. S. & Lee, B. K. National estimates of blood lead, cadmium, and mercury levels in the Korean general adult population. PubMed

Vupputuri, S. et al. Blood lead level is associated with elevated blood pressure in Blacks. PubMed

Kolossa-Gehring, M., Pack, L. K., Hülck, K. & Gehring, T. HBM4EU from the coordinator’s perspective: lessons learnt from managing a large-scale EU project. PubMed

Kolossa-Gehring, M. et al. Special issue editorial: key results of the European human biomonitoring initiative - HBM4EU. PubMed

Hrubá, F. et al. Blood cadmium, mercury, and lead in children: an international comparison of cities in six European countries, and china, ecuador, and Morocco. PubMed

UBA. (2008). https://www.umweltbundesamt.de/sites/default/files/medien/publikation/long/3355.pdf

Remy, S. et al. Intelligence gain and social cost savings attributable to environmental lead exposure reduction strategies since the year 2000 in flanders, Belgium. PubMed PMC

Bates, D., Mächler, M., Bolker, B. & Walker, S. Fitting linear mixed-effects models using lme4.

CDC. Centers for disease control and prevention. Fourth national report on human exposure to environmental chemicals. (2012). https://stacks.cdc.gov/view/cdc/75822

Bartlett, E. S. & Trasande, L. Economic impacts of environmentally attributable childhood health outcomes in the European union. PubMed

von Storch, H. et al. Four decades of gasoline lead emissions and control policies in europe: a retrospective assessment. PubMed

Batáriová, A. et al. Blood and urine levels of pb, cd and hg in the general population of the Czech Republic and proposed reference values. PubMed

Clark, N. A., Teschke, K., Rideout, K. & Copes, R. Trace element levels in adults from the West Coast of Canada and associations with age, gender, diet, activities, and levels of other trace elements. PubMed

Egan, K. B., Cornwell, C. R., Courtney, J. G. & Ettinger, A. S. Blood lead levels in U.S. Children ages 1–11 years, 1976–2016. PubMed PMC

Rooney, J. P. et al. Blood lead levels in 2018/2019 compared to 1987/1988 in the German population-based KORA study. PubMed

Becker, K. et al. German environmental survey 1998 (GerES III): environmental pollutants in blood of the German population. PubMed

Hahn, D. et al. The role of dietary factors on blood lead concentration in children and adolescents - Results from the nationally representative German environmental survey 2014–2017 (GerES V). PubMed

Jakubowski, M. Low-level environmental lead exposure and intellectual impairment in children–the current concepts of risk assessment. PubMed

Schulz, C. et al. Twenty years of the German environmental survey (GerES): human biomonitoring–temporal and Spatial (West germany/east Germany) differences in population exposure. PubMed

White, M. A. & Sabbioni, E. Trace element reference values in tissues from inhabitants of the European union. X. A study of 13 elements in blood and urine of a united Kingdom population. PubMed

Torre, M. Women in blue: structural and individual determinants of sex segregation in blue-collar occupations.

Navas-Acien, A. et al. Lead, cadmium, smoking, and increased risk of peripheral arterial disease. PubMed

Obeng, A., Roh, T., Aggarwal, A., Uyasmasi, K. & Carrillo, G. The contribution of secondhand tobacco smoke to blood lead levels in US children and adolescents: a cross-sectional analysis of NHANES 2015–2018. PubMed PMC

Oleko, A. et al. Estimation of blood lead levels in the French population using two complementary approaches: Esteban (2014–2016) as part of the human biomonitoring program and the National surveillance system for childhood lead poisoning (2015–2018). PubMed

Zhou, C. C., He, Y. Q., Gao, Z. Y., Wu, M. Q. & Yan, C. H. Sex differences in the effects of lead exposure on growth and development in young children. PubMed

Vahter, M., Berglund, M., Akesson, A. & Lidén, C. Metals and women’s health. PubMed

Kim, Y. et al. Blood metal concentrations of manganese, lead, and cadmium in relation to serum ferritin levels in Ohio residents. PubMed

Hwang, Y. H. et al. Transition of cord blood lead level, 1985–2002, in the Taipei area and its determinants after the cease of leaded gasoline use. PubMed

von Storch, H. & Hagner, C. Controlling lead concentrations in human blood by regulating the use of lead in gasoline. PubMed

EEA (European Environment Agency). Air Quality in Europe. Report No 09/2020. https://www.eea.europa.eu/en/analysis/publications/air-quality-in-europe-2020-report

Liu, Q. et al. Early-life exposure to lead changes cardiac development and compromises long-term cardiac function. PubMed

Landrigan, P. et al. The declaration of Brescia on prevention of the neurotoxicity of metals June 18, 2006. PubMed

Ericson, B. et al. Blood lead levels in low-income and middle-income countries: a systematic review. PubMed

CDC. Centers for Disease Control and Prevention. Blood lead reference value. (2024). https://www.cdc.gov/lead-prevention/php/data/blood-lead-surveillance.html?CDC_AAref_Val=https://www.cdc.gov/nceh/lead/data/blood-lead-reference-value.htm

Larsen, B. & Sánchez-Triana, E. Global health burden and cost of lead exposure in children and adults: a health impact and economic modelling analysis. PubMed

Wani, A. L., Ara, A. & Usmani, J. A. Lead toxicity: a review. PubMed PMC

Richter, P. A., Bishop, E. E., Wang, J. & Kaufmann, R. Trends in tobacco smoke exposure and blood lead levels among youths and adults in the united states: the National health and nutrition examination survey, 1999–2008. PubMed PMC