Public Health Implications of Lead Exposure at Indoor Firing Ranges in the United States: Quantitative Estimates of Health Impacts

2025 · doi:10.1101/2025.11.02.25339289
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This paper modeled adult cardiovascular, renal, and cognitive health impacts attributable to lead exposure from indoor firing ranges in the United States by synthesizing blood lead data from Laidlaw et al. (2017) and NHANES 2015–2022, while applying EPA (2024) Integrated Science Assessment dose-response relationships and related epidemiologic evidence. Using estimates of about 16,000–18,000 indoor ranges serving 2–3 million users annually, it found that average user blood lead levels (4–12 µg/dL) exceed the CDC reference value of 5 µg/dL and are associated with modeled increases in systolic blood pressure, additional hypertension and myocardial infarctions, renal function decline, and reduced cognitive scores in more heavily exposed groups. A major caveat is that outcomes are based on modeled dose-response effects using secondary data sources rather than direct measurement of clinical endpoints in range users. Relevance to endometriosis: the paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Background Although population blood lead levels (BLLs) have fallen dramatically since the removal of leaded gasoline and paint, lead remains an important environmental and occupational toxicant. Indoor firing ranges uniquely combine confined airspaces, repeated detonations, and lead based ammunition conditions that result in persistent exposure for millions of users. Objectives To quantify adult cardiovascular, renal, and cognitive health impacts associated with lead exposure from indoor firing ranges in the United States using the most recent dose-response relationships from the United States Environmental Protection Agency (EPA) Integrated Science Assessment (ISA) for Lead (2024) and recent epidemiologic evidence. Methods Blood lead data from Laidlaw et al. (2017) and 2017–2025 citations were synthesized with NHANES 2015–2022 data (Day, Braun & Hoover 2025). Dose-response coefficients came from EPA ISA (2024) and the Summary Table—Adult BLL Dose-response Relationships. Health outcomes were modeled for adults using an estimated 16,000–18,000 indoor ranges serving 2–3 million users annually. Results Average BLLs among users (4–12 µg/dL) exceeded the United States Centers for Disease Control (CDC) reference value of 5 µg/dL. Modeled effects included a 5–8 mm Hg rise in systolic blood pressure, 20,000–40,000 additional hypertension cases, and 1,000–3,000 extra myocardial infarctions each year. Renal function declined 3–6 mL min⁻¹ 1.73 m⁻² and cognitive scores fell 0.2–0.3 SD among heavily exposed groups. Conclusions Most indoor ranges operate at BLLs above thresholds for cardiovascular and renal harm. Transition to lead-free ammunition and modern ventilation could prevent thousands of hypertension and cardiac events annually.
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Abstract

Background Although population blood lead levels (BLLs) have fallen dramatically since the removal of leaded gasoline and paint, lead remains an important environmental and occupational toxicant. Indoor firing ranges uniquely combine confined airspaces, repeated detonations, and lead based ammunition conditions that result in persistent exposure for millions of users.

Objectives

To quantify adult cardiovascular, renal, and cognitive health impacts associated with lead exposure from indoor firing ranges in the United States using the most recent dose-response relationships from the United States Environmental Protection Agency (EPA) Integrated Science Assessment (ISA) for Lead (2024) and recent epidemiologic evidence.

Methods

Blood lead data from Laidlaw et al. (2017) and 2017–2025 citations were synthesized with NHANES 2015–2022 data (Day, Braun & Hoover 2025). Dose-response coefficients came from EPA ISA (2024) and the Summary Table—Adult BLL Dose-response Relationships. Health outcomes were modeled for adults using an estimated 16,000–18,000 indoor ranges serving 2–3 million users annually.

Results

Average BLLs among users (4–12 µg/dL) exceeded the United States Centers for Disease Control (CDC) reference value of 5 µg/dL. Modeled effects included a 5–8 mm Hg rise in systolic blood pressure, 20,000–40,000 additional hypertension cases, and 1,000–3,000 extra myocardial infarctions each year. Renal function declined 3–6 mL min⁻¹ 1.73 m⁻² and cognitive scores fell 0.2–0.3 SD among heavily exposed groups.

Conclusions

Most indoor ranges operate at BLLs above thresholds for cardiovascular and renal harm. Transition to lead-free ammunition and modern ventilation could prevent thousands of hypertension and cardiac events annually. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study did not receive any funding. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Supplemental File Added to Main Manuscript File so they will be packaged together. Data Availability All data used in this study were obtained from the provided references which are publicly available.

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