Abstract Body (Do not enter title and authors here): Background: Despite declines in environmental lead exposure, it remains a significant public health issue, particularly for children and adolescents in low-income and minority communities. While the neurodevelopmental harms of lead are well documented, emerging evidence suggests that early-life exposure may also increase cardiometabolic risk during adolescence. Even low-level exposure, below current intervention thresholds, has been linked to adverse outcomes, underscoring the continued need for vigilance and prevention.

Objective: To examine associations between blood lead levels (BLL) and the prevalence of diabetes, hyperlipidemia, and hypertension in U.S. adolescents, and to explore how sex and insurance status modify these associations using data from the Environmental Influences on Child Health Outcomes (ECHO) National Cohort.

Methods: We analyzed cross-sectional data from 628 adolescents (mean age = 12.35 years, SD = 3.88). The sample was 53.5% female and 22.9% identified as Hispanic/Latino. The mean BLL was 1.38 µg/dL (SD = 6.09). Prevalence of diabetes, hyperlipidemia, and hypertension was 32.8%, 33.6%, and 33.1%, respectively. Insurance/employment status was operationalized as Medicare coverage (vs. not). Logistic regression models were fit for each cardiometabolic outcome, adjusting for race, ethnicity, sex, and Medicare status.

Results: Higher BLL was significantly associated with greater odds of diabetes (OR = 1.29, p = 0.007), with a stronger trend among males than females (p = 0.051 for sex). For hyperlipidemia, BLL was also a significant predictor (OR = 1.20, p = 0.028). Importantly, adolescents covered by Medicare had significantly higher odds of hyperlipidemia (OR = 2.06, p = 0.001), suggesting a link between socioeconomic vulnerability and lipid risk. BLL was not significantly associated with hypertension (OR = 1.11, p = 0.16), though Medicare coverage remained marginally significant in that model (p = 0.049). Race and ethnicity were not significant covariates across models.

Conclusion: In this national sample of adolescents, elevated blood lead levels were associated with increased risk of diabetes and hyperlipidemia, with indications of sex-based differences in diabetes risk and a pronounced role for Medicare coverage in hyperlipidemia outcomes. These findings suggest that both environmental and socioeconomic factors contribute to early cardiometabolic vulnerability and should be central to prevention efforts targeting youth health equity.