Blood lead levels in the general population of Taiwan, Republic of China

Blood lead (Pb) is associated with lung fibrotic changes in non-smokers living in the vicinity of petrochemical complex: a population-based study

Lead (Pb) is a toxic metal that has been extensively used in various industrial processes, and it persists in the environment, posing a continuous risk of exposure to humans. This study investigated blood lead levels in participants aged 20 years and older, who resided in Dalinpu for more than two years between 2016 to 2018, at Kaohsiung Municipal Siaogang Hospital. Graphite furnace atomic absorption spectrometry was used to analyze the blood samples for lead levels, and the LDCT (Low-Dose computed tomography) scans were interpreted by experienced radiologists. The blood lead levels were divided into quartiles, with Q1 representing levels of ≤1.10 μg/dL, Q2 representing levels of >1.11 and ≤1.60 μg/dL, Q3 representing levels of >1.61 and ≤2.30 μg/dL, and Q4 representing levels of >2.31 μg/dL. Individuals with lung fibrotic changes had significantly higher (mean ± SD) blood lead levels (1.88±1.27vs. 1.72±1.53 μg/dl, p< 0.001) than those with non-lung fibrotic changes. In multivariate analysis, we found that the highest quartile (Q4: >2.31 μg/dL) lead levels (OR: 1.36, 95% CI: 1.01-1.82; p= 0.043) and the higher quartile (Q3: >1.61 and ≤2.30 μg/dL) (OR: 1.33, 95% CI: 1.01-1.75; p= 0.041) was significantly associated with lung fibrotic changes compared with the lowest quartile (Q1: ≤1.10 μg/dL) (Cox and Snell R², 6.1 %; Nagelkerke R², 8.5 %). The dose-response trend was significant (P_trend= 0.030). Blood lead exposure was significantly associated lung fibrotic change. To prevent lung toxicity, it is recommended to maintain blood lead levels lower than the current reference value.

Trend in blood lead levels in Taiwanese adults 2005-2017

This study examined the trend of blood lead levels (BLLs) in Taiwanese adults and analyzed the variations in the BLL between Linkou (northern) and Kaohsiung (southern) hospital branches. Between 2005 and 2017, 3,804 adult participants received blood lead tests at the Linkou (n = 2,674) and Kaohsiung (n = 1,130) branches of Chang Gung Memorial Hospital. The geometric mean of BLL was 2.77 μg/dL. The adult participants from the Kaohsiung branch were not only age older (49.8±14.1 versus 39.4±14.2 years; P<0.001) and male predominant (65.8 versus 41.7%; P<0.001) but also showed a higher BLL (4.45±3.93 versus 2.82±2.42 μg/dL; P<0.001) and lower estimated glomerular filtration rate (87.62±25.94 versus 93.67±23.88; P<0.001) than those from the Linkou branch. Multivariable logistic regression analysis revealed that the Kaohsiung branch [odds ratio (OR): 7.143; 95% confident interval (CI): 5.682–8.929; P<0.001], older age (OR: 1.008; 95% CI: 1.000–1.015; P = 0.043) and reduced estimated glomerular filtration rate (OR: 1.009; 95% CI: 1.004–1.014; P = 0.001) were significant predictors for BLL > 5 μg/dL. Therefore, this study confirmed a continuous decreasing trend in the BLL in Taiwan after banning leaded petrol in 2000.

Association of blood heavy metals with developmental delays and health status in children

The aim of this study was to evaluate the association of blood lead, mercury, and cadmium concentrations with developmental delays and to explore the association of these concentrations with the health status of children. This study recruited 89 children with developmental delays and 89 age- and sex-matched children with typical development. Their health status was evaluated using the Pediatric Quality of Life (PedsQL) Inventory for health-related quality of life (HRQOL) and the Pediatric Outcomes Data Collection Instrument for function. Family function was also evaluated. Blood lead, mercury, and cadmium concentrations were measured using inductively coupled mass spectrometry. The children with developmental delays had a considerably poorer HRQOL, lower functional performance and family function, and a higher blood lead concentration than those with typical development. The blood lead concentration had a significantly positive association with developmental delays [odds ratio (OR) = 1.54, p < 0.01] in a dose-response manner, and it negatively correlated with PedsQL scores (regression coefficient: −0. 47 to −0.53, p < 0.05) in all the children studied. The higher blood cadmium concentration showed a significantly positive association with developmental delays (OR = 2.24, for >1.0 μg/L vs. <0.6 μg/L, p < 0.05). The blood mercury concentration was not associated with developmental delays and health status.

Lead concentration in the blood of the general population living near a lead-zinc mine site, Nigeria: Exposure pathways

Lead (Pb) poisoning in children is a major public health catastrophe worldwide. This report summarises both exposure pathways and blood Pb levels in children below 7 years of age and adults (above 18 years) from the Adudu community living near a lead-zinc mine in Nasawara, Nigeria. The average and median blood Pb levels in children and adults were 2.1 and 1.3 μg/dL, 3.1 and 1.8 μg/dL, respectively. However, Pb in 14% of adults' blood exceeded 5 μg/dL, which is the recommended threshold blood Pb concentration in adults as established by the Centers for Disease Control and Prevention (CDC). Furthermore 68% of adults' blood exceeded blood Pb action level of 2 μg/dL. For children, 11.4% and 31% of the blood samples exceeded 5 μg/dL and 2 μg/dL, respectively, while no safe blood Pb level in children has been recommended. In Nasawara, a significant difference (p<0.05) was observed between the various age groups in children with 2-4 years old having the highest levels and 6 year old children having the lowest Pb levels. Although this study did not detect elevated levels of Pb in children's blood in regions such as Zamfara, Nigeria and Kabwe, Zambia, a high percentage of samples exceeded 2 μg/dL. Soils, floor dusts, water and crops also reveal that Pb contamination in the study area could potentially be the major cause of blood Pb in the community exposed to mining. This study also observed a significant correlation between water Pb levels of adults and blood Pb levels, suggesting that water is the major exposure pathway. This analysis highlights the need to properly manage mining activities so that the health of communities living in the vicinity of a Pb-Zn mine is not compromised.

Bioassay as monitoring system for lead phytoremediation through Crinum asiaticum L

Toxicity of lead in soil is well documented and established. Phytoremediation has gained attention as a cheap, easily applicable, and eco-friendly clean-up technology. Chemical methods are used to assess exact levels and type of pollutants but heavy metal content in soil can also be evaluated indirectly by estimation of phytotoxicity levels using bioassays. Plant bioassays through fast germinating cereals can indicate not only the level of pollution and its effects on growth and survival but also the progress of phytoremediation process. The performance of barley Hordeum vulgare L. seedlings as bioassay for assessment of changes in the levels of lead (Pb) at three concentrations, i.e., 300 (T(1)), 600 (T(2)), and 1,200 ppm (T(3)) in the soil was evaluated while testing the efficiency of Crinum asiaticum L. as a phytoremedial tool. At the first assessment, i.e., 30 DAT (days after treatment) shoot and root lengths of seedlings decreased with increasing concentrations of Pb. As the study progressed, a decrease in levels of Pb was accompanied by better germinability and growth of barley. At 120 DAT seedling growth in all the treatments were comparable to control. In T(1), T(2), and T(3) soils, 74.5%, 83.7%, and 91.2% reduction in lead content was observed at 120 DAT. Highly significant correlations between decreasing pollutant (Pb) content in the soil, seed germination, and seedling growth of barley H. vulgare were found. The differences in root and shoot length as well as overall growth pattern are indicative of the suitability of barley as a bio-monitoring tool.

Association between a polymorphism of aminolevulinate dehydrogenase (ALAD) gene and blood lead levels in Japanese subjects

This cross-sectional study investigated the relationship between the aminolevulinate dehydrogenase (ALAD) genotype and blood lead levels among 101 Japanese workers. Blood lead concentration measurement, biomarkers, and genotyping were performed. The minor allele frequency (MAF) for ALAD (ALAD2) was 0.08. Although the blood lead level in the subjects with heterozygous GC genotype was significantly higher than those with homozygous GG genotype, there were no significant differences for hemoglobin, hematocrit, serum and urinary ALA levels among genotypes. ALAD2 genotype was significantly associated with the blood lead concentration, even in the environmental lead exposed subjects. Further confirmation with a large sample size is needed.

Lead and cadmium levels in daily foods, blood and urine in children and their mothers in Korea

OBJECTIVES

The present study was initiated to examine the dietary intake, blood level and urinary concentration of lead (Pb) and cadmium (Cd) among children in Korea, in comparison with the findings in their mothers.

METHODS

Peripheral blood, spot urine and 24-h food duplicate samples were collected in Busan, Korea, from 38 pairs of children (4-10 years of age) and their mothers (28-46 years, non-smoking, mostly housewives), who provided informed consent. Samples were wet-ashed by being heated in the presence of mineral acids, and Pb and Cd in the wet-ashed samples were analyzed by graphite furnace atomic absorption spectrometry. Pb and Cd in food (Pb-F, Cd-F), blood (Pb-B, Cd-B) and urine [observed value (Pb-Uob, Cd-Uob), and values corrected for creatinine (Pb-Ucr, Cd-Ucr) or a specific gravity (1.016; Pb-Usg, Cd-Usg)] were presented in terms of geometric mean (GM) and geometric standard deviation (GSD).

RESULTS

Pb-F and Cd-F in the children were 0.337 microg Pb and 0.457 microg Cd/kg body weight per day as GM, respectively. Pb-B and Cd-B were 38.0 microg Pb and 1.51 microg Cd/l, and Pb-U and Cd-Uob were 5.44 microg Pb/l and 1.33 microg Cd/l, respectively. Pb-F and Pb-B for children were not significantly different from the values for their mothers. In contrast, Cd-F and Cd-B were significantly different between children and their mothers. Cd-F for children correlated with Cd-F for mothers, but no significant correlation was observed in Cd-B, Cd-U, Pb-F, Pb-B or Pb-U between children and their mothers. The dietary intake of Pb in total Pb intake (i.e., respiratory and dietary intake) accounted for 51.7 and 64.8% in children and their mothers, respectively, whereas the corresponding proportions were 97.8 and 98.2%, respectively, for Cd.

CONCLUSION

Cd intake was exclusively from food, both in children and mothers. Dietary Cd intake of children significantly correlated with that of their mothers. Dietary Pb intake in children, however, did not correlate with that of their mothers. Pb uptake from ambient air tended to be higher in children than in their mothers.

A pilot survey of blood lead levels in various types of workers in the United Arab Emirates

The aim of the present study is to determine the effect of blood lead on the health of industrial workers in United Arab Emirates (UAE). This is a cross-sectional pilot survey of blood lead levels (BLL) of 100 industrial workers (exposed) and 100 non-industrial workers (nonexposed), matched for age, sex and nationality selected from Al-Ain, Abu-Dhabi Emirate. Industrial workers had significantly higher mean of BLL (77.5+/-42.8 microg/dl and median 80.9 microg/dl) than non-industrial workers (19.8+/-12.3 microg/dl and median 11.0 microg/dl). In the present study, reported symptoms among industrial workers were strongly associated with BLL nausea/vomiting, muscular symptoms, dizziness, fatigue, irritability, memory disturbances, insomnia and allergic conjuctivitis, rhinitis and dermatitis. Furthermore, the present study revealed that industrial workers had higher prevalence of respiratory symptoms for phlegm, shortness of breath and diagnosed asthma. In conclusion, this study determined that occurrence of certain symptoms might be associated with lead exposure among industrial workers.

Exposure of women in general populations to lead via food and air in East and Southeast Asia

BACKGROUND

Despite increasing public concern of the possible health effects of lead (Pb) on general populations, reports on Pb levels in blood (Pb-B) and urine (Pb-B), as well as Pb intake via foods (Pb-F) for many Asian countries are scarce. The present study was initiated to elucidate the extent of non-occupational Pb exposure among general populations in East and Southeast Asia.

METHODS

In 1991-1997, peripheral blood, morning spot urine and 24-hour food duplicate samples were collected from 20 to 50 non-smoking adult women in each of four cities in Southeast Asia and five cities in Mainland China, and two cities each in Japan and Korea. The samples were wet-ashed and then analyzed by inductively coupled plasma mass spectrometry for Pb-B, Pb-U and Pb-F. Measures after logarithmic conversion were subjected to ANOVA and regression analysis.

RESULTS

Geometric mean values in cities in East and Southeast Asia were in ranges of 32-65 microg/L for Pb-B, 2.1-7.5 microg/g cr for Pb-Ucr, and 7-32 microg/day for Pb-F. The values for a combination of two cities of Tokyo and Kyoto, Japan (38 microg/L for Pb-B and 9.3 microg/day for Pb-F) appeared to be lower than the values for other Asian cities, and the values for all Japan (thus including both urban and rural areas) were even lower (19 microg/L for Pb-B and 7.7 microg/day for Pb-F). Comparison of Pb uptake via respiratory and dietary routes showed that Pb via dietary route accounted for 15% of the total in Manila where Pb in air was high (ca. 650 ng/m(3)), whereas it was 54% in Tokyo+Kyoto where Pb in air was low (ca. 75 ng/m(3)).

CONCLUSIONS

When compared internationally, Pb-F and Pb-B in Asia in general are similar to or somewhat higher than the levels in Europe and USA, whereas the levels in Japan are probably lower than the two latter areas. In Asia, Pb-F accounted for 15-54% of all Pb sources, the percentage being variable depending on local conditions especially Pb in atmospheric air.

Urban population exposure to lead and cadmium in east and south-east Asia

Information is still scarce for many Asian countries on general population exposure to two potentially toxic heavy metals of lead (Pb) and cadmium (Cd). The present review on publications from this study group is intended to provide an overview of the non-occupational exposure to Pb and Cd among general populations in east and south-east Asia. During the period of 1991-1998, surveys were conducted in four cities in south-east Asia, five cities in mainland China, and two cities each in Japan and Korea. Peripheral blood, morning spot urine and 24-h food duplicate samples were collected from 20-50 non-smoking adult women in each survey site. The samples were digested by heating in the presence of mineral acids, and then analyzed by inductively-coupled plasma mass spectrometry for the metals in blood (Pb-B and Cd-B), in urine (Pb-U and Cd-U), and in food duplicate (Pb-F and Cd-F). Measures were subjected to statistical analysis with an assumption of log-normal distribution. Pb-B, Pb-U and Pb-F levels varied substantially among the 11 urban sites; GM distributed in ranges of 32-65 microg/l for Pb-B, 2.1-7.5 microg/g cr (creatinine) for Pb-U, and 7-32 microg/day for Pb-F. The same was also the case for Cd exposure parameters, the distribution ranges being 0.5-1.8 microg/l for Cd-B, 1.2-3.1 microg/g cr for Cd-U, and 5-32 microg/day for Cd-F. It appeared that the exposure to Pb and Cd was highest in Kuala Lumpur, and Tokyo + Kyoto, respectively, and lowest in Tokyo + Kyoto and in Manila. Additional surveys in Japan showed that Pb exposure was even lower in rural areas than in Tokyo + Kyoto. When compared with the values reported in the literature, Pb exposure levels among Asian populations appear to be similar to the levels in Europe and in the United States, whereas Cd exposure seems to be higher in Asia than in Europe. The contribution of the dietary route in Pb absorption was variable and was inversely related to the extent of air pollution, whereas Cd uptake was almost exclusively via the dietary route with little contribution of the respiratory route.

Background lead and cadmium exposure of adult women in Xian City and two farming villages in Shaanxi Province, China

The objectives of the present study are: (a) to clarify the current levels of environmental exposure to lead (Pb) and cadmium (Cd) in Shaanxi Province in China in comparison with levels in other parts of mainland China; (b) to examine if there is any urban-rural difference in Pb and Cd exposure; and (c) to quantify the role of cereals as the dietary source of environmental exposure to these metals. For this purpose, triplet surveys on lead and cadmium exposure were conducted in the provincial capital of Xian and two farming villages A and B in Shaanxi Province, China in 1997. The grand geometric mean for lead (Pb) intake via foods (Pb-F), Pb in blood (Pb-B) and Pb in urine as corrected for creatinine concentration (Pb-Ucr) were 30 micrograms/day, 33 micrograms/l and 5 micrograms/g creatinine, respectively, with significant differences among the survey sites, e.g. Pb-B being higher in Xian (43 micrograms/l) than in the two villages (38 and 22 micrograms/l). The counterpart values for cadmium (Cd) intake via foods (Cd-F), Cd in blood (Cd-B) and Cd in urine (Cd-Ucr) were 6.1 micrograms/day, 0.46 microgram/l and 2.8 micrograms/g creatinine, respectively, with no substantial inter-survey site difference. Thus, it was possible to conclude that, from comparison with the values reported in 1990s literature, the exposure of Shaanxi people to Pb and Cd is no higher than, and even possibly lower than, the levels reported for people in other parts of mainland China. The exposure to Cd was almost exclusively from foods, whereas the exposure to air-borne Pb was large enough in Xian to explain higher Pb-B and Pb-Ucr than the level in Village B despite lower Pb-F in Xian than in Village B. Cereals (wheat, rice, maize and foxtail millet) contributed 26 and 84% of dietary Pb and Cd intake, respectively.

Association between aminolevulinate dehydrogenase genotype and blood lead levels in Taiwan

This study was designed to evaluate the association between the aminolevulinate dehydrogenase (ALAD) genotype and blood lead levels in a general population environmentally exposed to lead. This study population of 660 subjects was secondarily sampled from the 3000 random samples of Taiwanese general population to study the distribution of blood lead levels in the Taiwanese population. A simple assay based on the polymerase chain reaction-restriction fragment length polymorphism technique was used to determine the genotype of the ALAD gene. This study found that most of the Taiwanese population was ALAD 1-1 (95.4%). Only 4.6% (30 subjects) of population were found to be 1-2 or 2-2. It has been hypothesized that the ALAD2 allele is associated with increased absorption of lead. This study found that individuals with ALAD2 alleles had 20% higher blood lead levels than persons with ALAD1 alleles (7.83 +/- 5.95 vs 6.51 +/- 5.03 micrograms/dL). However, the difference was not statistically significant, even after adjustment for other risk factors of environmental exposure. The result supports the previous finding that individuals with ALAD2 allele had higher blood lead levels. The small sample size and large amount of variation in our study may account for the insignificant association.

Reappraisal of the relation between blood lead concentration and blood pressure among the general population in Taiwan

OBJECTIVES

The relation between blood lead concentration (PbB) and blood pressure was examined in a Taiwan nationwide population survey of PbB from July 1993 to June 1994.

METHODS

After multistage sampling procedures, 2800 subjects (1471 males and 1329 females) with a mean (range) age of 44 (15-85) years were enrolled in this study. Anthropometric, blood pressure, and lifestyle factors were measured during household visits. The PbB was measured with a flameless atomic absorption spectrophotometer and all specimens were analysed in triplicate.

RESULTS

The mean (range) PbB among all study subjects was 6.5 (0.1-69.1) micrograms/dl; among males it was 7.3 (0.1-69.1) micrograms/dl and among females 5.7 (0.1-40.1) micrograms/dl). The mean (range) systolic blood pressure among all subjects was 123 (80-210) mm Hg, among males it was 127 (80-200) mm Hg and among females 119 (80-210) mm Hg. The diastolic blood pressure among all subjects was 78 (40-150) mm Hg; among males it was 80 (40-130) mm Hg; and among females 75 (40-150) mm Hg. Age, body height, body weight, and body mass index (BMI) were significantly correlated with systolic blood pressure or diastolic blood pressure in both sexes. The PbB (or the natural logarithmic transformed PbB) was not significantly correlated with blood pressure among males or females. After adjustment for the potential confounders of age, age2, BMI, milk intake, alcohol consumption, and cigarette smoking, systolic blood pressure was significantly associated with PbB among males with a regression coefficient (beta) of 0.185 (p = 0.015). No significant association between PbB and blood pressure was found among females.

CONCLUSIONS

From this study, only a weak association between systolic blood pressure and PbB was found among males. There was no strong evidence that PbB was a good predictor of blood pressure. However, the possibility that long term high body lead burden could cause high blood pressure could not be ruled out on the basis of this survey.

Risk factors for high blood lead levels among the general population in Taiwan

PURPOSE

Environmental and occupational lead pollution is a common problem in both developing and industrialized countries. The purpose of this study is to evaluate the risk factors for high blood lead levels among the general population in Taiwan.

METHODS

After multi-stage sampling, we randomly selected 2803 subjects (1471 males and 1332 females) for this study. Univariate and multivariate logistic regression analyses were conducted to evaluate the risk of high blood lead. To control for differences in age and gender, all analyses were with age-adjusted and gender-stratified.

RESULTS

Among males, the mean age is 46 years (15 to 85 years), mean and median blood lead levels is 7.3 and 6.3 microg/dl, respectively. Among females, the mean age is 43 years (15 to 84 years), mean and median blood lead level is 5.7 and 4.8 microg/dl, respectively. Among males, the history of herbal drug use, drinking water from well or spring sources, and occupational lead exposure are significantly different between relatively high and normal blood lead level subjects. The history of occupational lead exposure, history of herbal drug use, and well or spring sources of drinking water are the major risk factors for high blood lead with odds ratio of 4.62 (95% CI: 2.82-7.55), 3.09 (95% CI: 1.60-5.97), 2.06 (95% CI: 1.13-3.76), and 2.37 (95% CI: 1.39-4.04), respectively. Among females, these characteristics remain important except the sources of drinking water. The history of herbal drug use and occupational lead exposure become the major risk factors for high blood lead with odds ratio of 2.94 (95% CI: 1.26-6.88) and 7.72 (95% CI: 3.51-16.99), respectively. In multivariate logistic regression analyses, we find that the risk factors for high blood lead in both genders include a history of herbal drug use and occupational lead exposure. Among males, the drinking water sources and factories in the neighboring areas are also significant factors for high blood lead.

CONCLUSIONS

For the goal of reducing prevalence of high blood lead by the year 2000, the improvement and monitoring of the working environment, the careful attention to herbal drug use and the lead-free drinking water sources should be executed as thoroughly as possible to reduce the probability of lead pollution.

Reducing lead exposure by surveillance system: the Taiwan experience

To evaluate the performance of a lead-surveillance program in reducing blood lead levels of workers in Taiwan, the authors conducted prospective and cross-sectional studies. A total of 6 905 workers, whose job titles indicated a direct exposure to lead in 1995, were included in this surveillance system. In this study, the authors compared the mean blood lead levels in 1994 (i.e., year of onset of surveillance) with that in 1995 in workers of major industries. Lead-exposed workers had a statistically significant decrease (i.e., average of 1.8 microg/dl) in blood lead levels during this 1-y period. The decrease was particularly obvious in individuals who worked in chemical products manufacturing, ship building/repairing, and plastic products manufacturing. The significant decreases in blood lead levels in these workers indicated that this surveillance system was effective. Surveillance, combined with control measures, might be an important means by which occupational lead exposure can be reduced.

Lead poisoning caused by contaminated Cordyceps, a Chinese herbal medicine: two case reports

Two cases of lead poisoning, caused by the Chinese herbal medicine Cordyceps, were reported to the Department of Health in a laboratory-based blood lead surveillance program. Such unusual cases of lead poisoning have not been previously reported. These two patients took Cordyceps herbal medicine for treatment of underlying diseases. Loss of appetite and anemic signs of lead poisoning were manifested in one patient with a blood lead level of 130 microg/dl, while the other patient was asymptomatic with a blood lead level of 46 microg/dl. The lead content in the Cordyceps powder was found to be as high as 20 000 ppm. After cessation of intake in the asymptomatic patient, and cessation of intake and treatment with chelating agents in the symptomatic patient, the blood lead levels returned to normal range. This report raises concerns about lead poisoning from unusual herbal medicine worldwide.

Blood lead levels in Taiwanese adults: distribution and influencing factors

Five-thousand nine-hundred thirteen Taiwanese adults were selected by multistage sampling methods to investigate environmental lead exposure in Taiwan. The blood specimens were distributed to six laboratories for blood lead levels (BLL) measurement. The mean BLL of the 5913 Taiwanese adults was 8.28 +/- 5.39 microg/dl, with a maximum level of 57.6 microg/dl. The median was 7.0 microg/dl and 90th percentile was 15.0 microg/dl. BLLs were associated with gender, ethnic group, education level, smoking, alcohol consumption, herbal drug consumption, milk consumption, sources of drinking water, level of urbanization, and occupational lead exposure. These results showed that BLLs in Taiwanese adults were stable during the 2-year study. Most of the influencing factors were consistent with other studies, while local risk factors, such as Chinese herbal drug consumption are important ways of preventing the general population from overexposure to lead.

Three-year survey of blood lead levels in 8828 Taiwanese adults

The purpose of this study was to investigate environmental lead exposure in the general Taiwanese population. A total of 8828 Taiwanese adults selected by a multistage sampling method were investigated. Characteristics of the participants were ascertained by questionnaire and 10 ml venous blood was drawn by public health nurses. The blood specimens were distributed to six laboratories for blood lead level (BLL) measurement. A quality control program was applied during the analysis of the BLLs in order to improve precision and accuracy. The arithmetic mean BLL of the 8828 Taiwanese adults was 7.70 +/- 5.23 micrograms/dl, with a maximal level of 69.1 micrograms/dl. The median was 6.5 micrograms/dl and the 90th percentile was 14.0 micrograms/dl. After logarithmic transformation, the geometric mean was 1.84 +/- 0.67 microgram/dl. This study also found that elevated BLLs were associated with certain personal characteristics, i.e., gender, ethnic group, and education level; life-style factors, such as smoking, alcohol consumption, Chinese herbal drug consumption, milk consumption, and sources of drinking water; residential location, i.e., level of urbanization; and occupational history of lead exposure. However, age, floor level of residence, distance from house to road, and betel nut consumption were not associated with elevated BLLs. These results showed that BLLs in the Taiwanese population were not higher than those in developed and developing countries. Most of the influencing factors were also found in other studies; however, local factors such as ethnic group, Chinese herbal drug consumption, and sources of drinking water are important considerations in Taiwan when examining ways to prevent overexposure to lead in the general population.