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

BackgroundAlthough 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. ObjectivesTo 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. MethodsBlood 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. ResultsAverage BLLs among users (4-12 {micro}g/dL) exceeded the United States Centers for Disease Control (CDC) reference value of 5 {micro}g/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-{superscript 1} 1.73 m-{superscript 2} and cognitive scores fell 0.2-0.3 SD among heavily exposed groups. ConclusionsMost 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.