Sex-specific determinants of blood lead levels in Korean adults

Abstract Blood lead level (BLL) in Korea has declined but remains a public health concern because there is no safe level of exposure. We aimed to identify sex-specific determinants of BLL in Korean adults using an integrated, data-reduction approach. We analyzed data from the third cycle of Korean National Environmental Health Survey (KoNEHS, 2015–2017), a nationally representative survey of adults aged 19 years or older. A total of 3,747 participants and 123 variables were included in the final analysis. We applied categorical principal component analysis (CatPCA) to derive composite factors separately for men and women. Sex-stratified, survey-weighted linear regression models examined associations between z-standardized component scores and log-transformed BLL with Bonferroni correction for multiple testing. CatPCA identified 43 factors in men and 42 in women, including 25 common patterns. After correction, higher BLL in men were associated with factors reflecting current smoking, frequent alcohol consumption, long outdoor stay time, and home-based eco and smoke-free practices. In women, higher BLL was associated with infrequent dairy and fruit consumption, whereas frequent pesticide use was inversely associated. Determinants of BLL differed by sex in Korean adults. These findings support sex-tailored prevention strategies, emphasizing smoking, alcohol consumption, and prolonged outdoor exposure in men and dietary patterns and contextual environmental factors in women.