Disease burden of chronic kidney disease attributable to lead exposure: A global analysis of 30 years since 1990

Exposure to lead (Pb) is associated with an increased risk of chronic kidney disease (CKD). However, limited studies explored the global burden of CKD attributable to Pb exposure, especially in countries with different development levels. This study aimed to comprehensively evaluate the temporal and spatial trend in the disease burden of CKD attributable to Pb exposure in 204 countries and territories from 1990 to 2019.We used the data from Global Burden of Disease Study (GBD) 2019 to estimate annual deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized DALYs rate (ASDR) of CKD attributable to Pb exposure. The annual average percentage change (AAPCs) was calculated using the Joinpoint model to evaluate the changing trend of CKD ASMR and ASDR attributable to Pb exposure from 1990 to 2019. Meanwhile, age-period-cohort (APC) model was used to assess changes in the mortality of CKD attributable to Pb exposure from 1990 to 2019.Global ASMR for CKD attributable to Pb exposure trended upward from 1990 to 2019. ASMR and ASDR were the highest in low and low-middle SDI regions. With the APC model, we found that global mortality rates for CKD attributable to Pb exposure increased with age. The global period rate ratio showed the highest value in 2000-2004 and the lowest in 2015-2019, while the global cohort rate ratio showed the highest value in 1941-1949 and the lowest during 1986-1994.From 1990 to 2019, the global burden of CKD attributable to Pb exposure increased globally, especially in low and low-middle SDI regions, as well as the elderly. Pb exposure is still a great threat to the global burden of CKD, and the implementation of effective prevention measures to reduce Pb exposure in the environment should be continually strengthened.