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Your Environment. Your Health.

The attributable annual health costs of U.S. occupational lead poisoning

Environmental Health Economic Analysis Annotated Bibliography


Research article Cost analysis (CA)
Levin R
Int J Occupational Environ Health
This study examined the attributable annual societal costs of health damages associated with occupational lead exposure in U.S. workers. Results from the analysis revealed direct medical costs of $141 million (2014 US dollars) per year for 16 categories of health endpoints, and a combined amount of $392 million for direct and indirect costs (2014 US dollars) per year for the 10,000 or more U.S. workers with high occupational lead exposures. These results suggest reducing allowable occupational lead limits could produce annual societal benefits of almost $40,000 per highly exposed worker.
Adults (U.S. resident and non-resident workers, age not specified)

Health Outcomes

  • Cardiovascular outcomes (hypertension, myocardial infarctions)
  • musculoskeletal outcomes (muscular pain)
  • neurological/cognitive outcomes (ocular disorder, depression, nervous system disorder, pain disorder, dementia)
  • reproductive outcomes (male fertility damages, female fertility damages)
  • birth outcomes (preterm birth)
  • kidney outcomes (end stage renal disease (ESRD), chronic kidney disease)
  • cancer outcomes (lung cancer)
  • mortality/morbidity

Environmental Agents

List of Environmental Agents:

  • Metals (lead)

Source of Environmental Agents:

  • Occupational

Economic Evaluation / Methods and Source


  • Cost analysis (CA)

Cost Measured:

  • Direct medical costs associated with diagnosis, treatment, rehabilitation, and accommodation, including medical and other care provided at the work place, in a medical facility, or at home for all specified health outcomes of interest (health unit, equipment, transportation, out-of-pocket expenditures, etc.)
  • indirect costs associated with productivity, personal time loss for the individual (including the family) and employer, and specialized consumer products related to all conditions/outcomes of interest (lost work, costs)

Potential Cost Measures:

  • Costs related to health damages associated with other outcomes, such as cognitive and hearing decrements, or metabolic changes
  • valuation for pain, suffering, decreased quality of life, and similar others
  • costs associated with the suffering of family members and psychological hardships

Benefits Measures: (Not available)

Potential Benefits: (Not available)


  • United States

Models Used:

  • Author developed simple algorithms to monetize direct medical and indirect (productivity) damages associated with high lead exposures.

Methods Used:

  • The author estimated the attributable annual societal costs of health damages associated with occupationally lead-exposed U.S. workers, and developed methods for fuller valuation of health damages. The author — 1) used blood lead data collected through the National Institute of Occupational Safety and Health Adult Blood Lead Epidemiology and Surveillance (ABLES) program to estimate the number of U.S. occupationally lead-exposed workers; 2) used published literature and a COI or human capital approach to value health damages, which includes direct and indirect cost categories, and converted costs to 2014$; and 3) used effect slopes to calculate the number of workers suffering specific health damages, assuming blood lead levels will be reduced to 30 µg/dL.

Sources Used:

  • Adult Blood Lead Epidemiology and Surveillance (ABLES) Program (NIOSH, 2015); Elevated blood lead levels among employed adults - United States, 1994-2012 (Alarcon, 2015); Guidelines in preparing economic analyses (EPA, National Center for Environmental Economics, Office of Policy, 2014); additional sources cited in publication

Economic Evaluation / Methods and Source


  • Levin R. 2016. The attributable annual health costs of U.S. occupational lead poisoning. Int J Occupational Environ Health.
  • Pubmed
  • DOI

NIEHS Funding: (Not available)

Other Funding: (Not available)

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