Local Lead Data Are Needed for Local Decision Making

Abstract

In late 1998, the Maryland Department of the Environment, the agency responsible for maintaining the statewide childhood blood lead surveillance system, published a report1 indicating that (1) the city of Baltimore had the highest percentage of children with elevated blood lead levels and lead poisoning in Maryland and (2) prevalence rates of elevated blood lead levels and lead poisoning were, respectively, 7 and 16.5 times higher in Baltimore than in the United States as a whole (Table 1 ▶). Given these alarming statistics, the Childhood Lead Poisoning Prevention Program of the Baltimore City Health Department conducted a close examination of the Department of the Environment's data analyses. TABLE 1— Childhood Blood Lead Surveillance in Maryland: Summary Results From the Maryland Department of the Environment 1997 Annual Report During our review, we discovered major shortcomings in the structure and maintenance of the state blood lead database and in the department's data quality and analyses. These problems included lack of unique identifiers and a flawed approach to handling incomplete address information. Therefore, the ability to accurately track and interpret lead poisoning trends and screening rates over time and to relate blood lead surveillance data to the Department of the Environment's other lead poisoning databases was severely limited. We shared our findings regarding Maryland's blood lead surveillance system with other local environmental health directors who had similar concerns. Subsequently, we drafted recommendations for improving the state's childhood blood lead surveillance system and presented them to the Department of the Environment and the Maryland Department of Health and Mental Hygiene. Our recommendations included the following: Development and enforcement of the use of standardized laboratory report forms to be submitted to the Department of the Environment; Implementation of a relational database and improvement of quality control measures at the Department of the Environment; Creation of an electronic link for blood lead data transmission between the Department of the Environment, the Department of Health and Mental Hygiene, and local health departments; Improvement of the Department of the Environment's annual report through inclusion of (1) elevated blood lead level and blood lead poisoning incidence and prevalence rates, (2) demographic data, and (3) state and local blood lead concentration distributions. We learned 2 important lessons from our experience. First, the sharing of concerns about childhood lead poisoning surveillance among local environmental health directors and the joint presentation of recommendations to the state confirmed local public health as a critical link in environmental health. Second, our evaluation of lead surveillance in Maryland signaled a need to examine other lead programs. Lead exposure surveillance is often touted as a success story at the national level and as a model for the development of tracking mechanisms for other environmentally related surveillance efforts. However, current childhood blood lead surveillance practices at the state and local levels may not be as effective in regard to providing accurate, meaningful information to those who need it. Because there are no mandated federal guidelines for state blood lead surveillance systems and data collection methods, and because blood lead reporting levels vary among states, meaningful data analysis is limited. Surveillance is increasingly recognized as a crucial component of successful environmental health practice. As a result, this may be an opportune time not only to consider new areas for environmental health tracking but also to reevaluate and improve existing surveillance programs, including those focusing on blood lead poisoning.