Lead-attributable productivity losses in low- and middle-income countries.

This study estimates productivity losses resulting from intellectual decrement due to paediatric lead exposure in low- and middle-income countries (LMICs). The published literature on blood lead levels in LMICs was reviewed and summarised. Intelligence Quotient decrement and consequent productivity losses were calculated for a one-year cohort of 5-year-old children in each country. We calculated the present value of lifetime earnings as the discounted average earning potential for workers in a specific economy. Blood lead level (BLL) data for children were available for 39 countries and could be interpolated for additional 82 countries, resulting in 121 countries in the final analysis. Total lead-attributable productivity losses in LMICs ranged from USD 305 billion in our high discount scenario to USD 499 billion in our low discount scenario for each one-year cohort of 5-year-old children (2019 USD). As a share of GDP, these costs ranged from 0.7 to 4.2% by region, depending on discount scenario used. Total economic impacts were generally consistent with previous estimates and further validate those efforts with a substantially expanded dataset. Differences in the findings resulted primarily from the use of a more conservative dose-response model in the present study. Improved reporting of BLLs is essential and could be facilitated through a centralised registry of study results.