Association between lead exposure and increased risk of bronchial asthma in Korean adolescents

Sin Young Kang; Chang-Keun Kim

doi:10.4168/aard.2019.7.1.37

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Kang and Kim: Association between lead exposure and increased risk of bronchial asthma in Korean adolescents

Original Article

Allergy Asthma Respir Dis 2019;7(1):37-43.

Published online: 12 January 2019

DOI: https://doi.org/10.4168/aard.2019.7.1.37

Association between lead exposure and increased risk of bronchial asthma in Korean adolescents

Sin Young Kang, Chang-Keun Kim

^¹Asthma and Allergy Center, Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul Korea

Correspondence to: Chang-Keun Kim https://orcid.org/0000-0003-4119-2849 Asthma and Allergy Center, Department of Pediatrics, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea Tel: +82-2-950-1663, Fax: +82-2-950-1662, E-mail: kimck@paik.ac.kr

Received 11 August 2018 Revised 10 October 2018 Accepted 11 October 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Several studies have reported an association between lead exposure and increased risk of allergic sensitization and asthma. According to the Centers for Disease Control and Prevention guidelines, An elevated blood lead level (BLL) is defined as a BLL of ≥5 µg/dL. However, no safe BLL has been identified, and it is controversial whether a BLL of <5 µg/dL affects the risk of asthma.

Methods

We examined asthma prevalences and BLLs using data from the 2010–2013 Korea National Health and Nutrition Examination Survey (KNHANES), which was a cross-sectional survey of 1,478 adolescence (aged 10–19 years) throughout the country. The adjusted odds ratios (ORs) (with 95% confidence intervals [CIs]) for the prevalence of asthma in adolescence with elevated BLLs were calculated by complex samples multivariate logistic regression analysis. The presence of asthma was based on self-reported, physician-diagnosed asthma in the Health Interview Surveys.

Results

The mean of total BLLs was 1.33 μg/dL. Overall, 5.1% (n=71) of the subjects were physician diagnosed asthma. In the model controlling for population characteristics, the adjusted odds ratio for asthma per 1 μg/dL increase in blood lead was 1.94, 95% CI (1.06, 3.57), and stronger associations were observed among boys (adjusted OR, 2.31; 95% CI, [1.18, 4.51]). The group of BLL≥2 μg/dL was associated with an OR of 2.84 (95% CI, 1.06, 7.63) for asthma, after adjusting for potential confounding factors in boys.

Conclusion

Our results suggest an association between total BLLs and asthma in Korean adolescent boys, although confirmation is warranted in further prospective studies.

Keywords: Lead, Asthma, Allergic sensitization

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Fig. 1.

Predicted probability of asthma and observed asthma according to blood lead level (µg/dL). OR, odds ratio; CI, confidence interval.

Table 1.

General characteristics of participant

Characteristic	Male (n=758)	Female (n=720)	Total (n=1,478)	P-value
Age (yr)	14.59±0.115	14.61±0.116	14.6±0.116	0.870
Age group (yr)				0.825
10–12	246 (26.1)	218 (24.4)	464 (25.3)
13–15	265 (32.3)	251 (33.0)	516 (32.6)
16–19	247 (41.5)	242 (42.6)	498 (42.1)
BMI (kg/m²)				0.003*
BMI (kg/m) <25	646 (83.8)	659 (90.5)	1,305 (86.9)	0.003*
≥25	112 (16.2)	61 (9.5)	173 (13.1)
Vitamin D level (ng/mL)				<0.001*
Insufficiency (<20)	538 (72.6)	599 (84.2)	1,137 (78.1)
Sufficiency (≥20)	220 (27.4)	121 (15.8)	341 (21.9)
Residential region				0.623
Urban	544 (71.2)	517 (70.0)	1,061 (70.7)
Rural	214 (28.8)	203 (30.0)	417 (29.3)
Asthma diagnosis	40 (5.6)	31 (4.7)	71 (5.2)	0.474
Physical activity	276 (37.9)	119 (18.0)	395 (28.5)	<0.001*
Social income				0.491
Q1 (low)	83 (13.0)	93 (15.2)	176 (14.0)
Q2	205 (29.7)	197 (29.1)	402 (29.4)
Q3	233 (27.9)	226 (29.8)	459 (28.8)
Q4 (high)	237 (29.4)	204 (25.9)	441 (27.8)

Values are presented as mean±standard deviation or number (%).

BMI, body mass index; Q, quartile.

*P<0.05, statistically significant difference.

Table 2.

Association of study variables to asthma

Characteristic	Asthma (n=71)	Nonasthma (n=1,407)	P-value
Sex			0.474
Male	40 (57.1)	718 (52.5)
Female	31 (42.9)	689 (47.5)
Age group (yr)			0.755
10–12	26 (28.8)	438 (25.1)
13–15	19 (28.5)	497 (32.9)
16–19	26 (42.7)	472 (42.0)
BMI (kg/m²)			0.588
<25	63 (84.3)	1,242 (87.1)
≥25	8 (15.7)	165 (12.9)
Vitamine D level (ng/mL)			0.897
Insufficiency (<20)	51 (77.4)	1,086 (78.1)
Sufficiency (≥20)	20 (22.6)	321 (21.9)
Residential region			0.479
Urban	46 (65.9)	1,015 (70.9)
Rural	25 (34.1)	392 (29.1)
Physical activity			0.025*
Regular	25 (41.1)	370 (27.8)
Inactivity	46 (58.9)	1,037 (72.2)
Social income			0.85
Q1 (low)	8 (13.5)	168 (14.1)
Q2	19 (24.7)	383 (29.7)
Q2 Q3	19 (24.7)19 (29.4)	383 (29.7)440 (28.8)
Q3 Q4 (high)	19 (29.4)25 (32.4)	440 (28.8)416 (27.5)

Values are presented as number (%).

BMI, body mass index; Q, quartile.

*P<0.05, statistically significant difference.

Table 3.

Mean levels of blood lead levels according to participant general characteristics

Characteristic	No.	Pb (μg/dL), mean (95% CI)	P-value
Total	1,478	1.33 (1.30–1.36)
Sex			<0.001*
Male	758	1.46 (1.42–1.51)
Female	720	1.17 (1.14–1.21)
Age group (yr)			<0.001*
10–12	464	1.44 (1.39–1.50)
13–15	516	1.31 (1.25–1.36)
16–19	498	1.27 (1.23–1.32)
BMI (kg/m²)			0.599
<25	1,305	1.32 (1.29–1.36)
≥25	173	1.35 (1.25–1.45)
Vitamine D level (ng/mL)			0.003*
Insufficiency (<20)	1,137	1.30 (1.27–1.33)
Sufficiency (≥20)	341	1.43 (1.35–1.50)
Residential region			0.959
Urban	1,061	1.33 (1.29–1.36)
Rural	417	1.33 (1.27–1.39)
Asthma diagnosis			0.091
Asthma	71	1.51 (1.29–1.74)
Nonasthma	1,478	1.32 (1.29–1.35)
Physical activity			0.029*
Regular	395	1.38 (1.33–1.43)
Inactivity	1,083	1.31 (1.27–1.34)
Social income			0.26
Q1 (low)	176	1.38 (1.30–1.45)
Q2	402	1.35 (1.30–1.40)
Q3	459	1.31 (1.26–1.37)
Q3 Q4 (high)	459441	1.31 (1.26–1.37)1.29 (1.23–1.36)

BMI, body mass index; Q, quartile; CI, confidence interval.

*P<0.05, statistically significant difference.

Table 4.

Multivariable binary logistic regression OR (95% CI) of athma according to lead level by sex

Outcome	Male		Female		All sex
Outcome	OR (95% CI)	P-value	OR (95% CI)	P-value	OR (95% CI)	P-value
Crude	2.29 (1.16–4.54)	0.018*	1.11 (0.52–2.36)	0.789	1.90 (1.07–3.36)	0.027*
Adjusted	2.31 (1.18–4.51)	0.014*	1.07 (0.51–2.24)	0.864	1.94 (1.06–3.57)	0.032*

Adjust for age, obesity, vitamin D deficiency, residential region, physical activity, social income.

OR, odds ratio; CI, confidence interval.

* P<0.05, statistically significant difference.

Table 5.

Multivariable logistic regression odds ratio (95% CIs) of athma according to lead level (1, 1.5, 2 µg/dL) by sex

Sex	BLL (µg/dL), OR (95% CI)
Sex	<1	≥1	P-value	<1.5	≥1.5	P-value	<2	≥2	P-value
Male
Unadjusted	1	1.52 (0.53–4.38)	0.433	1	1.59 (0.74–3.41)	0.234	1	2.81 (1.13–6.97)	0.026*
Adjusted	1	1.52 (0.52–4.51)	0.446	1	1.59 (0.71–3.56)	0.255	1	2.84 (1.06–7.63)	0.039*
Female
Female Unadjusted	1	1.48 (0.64–3.39)	0.356	1	0.52 (0.18–1.56)	0.243	1	1.15 (0.26–5.26)	0.848
Adjusted	1	1.56 (0.70–3.47)	0.280	1	0.53 (0.18–1.58)	0.255	1	1.29 (0.27–6.20)	0.755

Adjust for age, obesity, vitamin D deficiency, residential region, physical activity, social income.

BLL, blood lead level; OR, odds ratio; CI, confidence interval.

*P<0.05, statistically significant difference.

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