Statewide assessment of lead poisoning and exposure risk among children receiving Medicaid services in Alaska.

Laura F Robin,John P Middaugh,Michael Beller

doi:10.1542/peds.99.4.e9

Abstract

Lead poisoning is a well-recognized public health concern for children living in the United States. In 1992, Health Care Financing Administration (HCFA) regulations required lead poisoning risk assessment and blood lead testing for all Medicaid-enrolled children ages 6 months to 6 years. This study estimated the prevalence of blood lead levels (BLLs) >/=10 microg/dL (>/=0.48 micromol/L) and the performance of risk assessment questions among children receiving Medicaid services in Alaska. Measurement of venous BLLs in a statewide sample of children and risk assessment using a questionnaire modified from HCFA sample questions. Eight urban areas and 25 rural villages throughout Alaska. Nine hundred sixty-seven children enrolled in Medicaid, representing a 6% sample of 6-month- to 6-year-old Alaska children enrolled in Medicaid. Determination of BLL and responses to verbal-risk assessment questions. BLLs ranged from <1 microg/dL (<0.048 micromol/L) to 21 microg/dL (1.01 micromol/L) (median, 2.0 microg/dL or 0.096 micromol/L). The geometric mean BLLs for rural and urban children were 2.2 microg/dL (0.106 micromol/L) and 1.5 microg/dL (0.072 micromol/L), respectively. Six (0.6%) children had a BLL >/=10 microg/dL; only one child had a BLL >/=10 microg/dL (11 microg/dL or 0.53 micromol/L) on retesting. Children whose parents responded positively to at least one risk factor question were more likely to have a BLL >/=10 microg/dL (prevalence ratio = 3.1; 95% confidence interval = 0.4 to 26.6); the predictive value of a positive response was <1%. In this population, the prevalence of lead exposure was very low (0.6%); only one child tested (0.1%) maintained a BLL >/=10 microg/dL on confirmatory testing; no children were identified who needed individual medical or environmental management for lead exposure. Universal lead screening for Medicaid-enrolled children is not an effective use of public health resources in Alaska. Our findings identify an example of the importance in considering local and regional differences when formulating screening recommendations and regulations, and continually reevaluating the usefulness of federal regulations.

Highlights

Alaska is geographically the largest state, with approximately one-sixth the land area of the United States (US), and a population density of less than one person per square mile (US average ϭ 70 persons per square mile).[8]
Universal lead screening for Medicaid-enrolled children is not an effective use of public health resources in Alaska
Our findings identify an example of the importance in considering local and regional differences when formulating screening recommendations and regulations, and continually reevaluating the usefulness of federal regulations

Summary

Introduction

Alaska is geographically the largest state, with approximately one-sixth the land area of the US, and a population density of less than one person per square mile (US average ϭ 70 persons per square mile).[8]. Many of the sources commonly associated with elevated BLLs in children[1] are not frequently found in Alaska, which has a low-population density, a limited road system, and where 52% of public[9] and Ͼ38% of all housing[8] has been built since 1980 (lead paint ceased to be used for residential purposes after 1978). The state has maritime industry, a battery factory, and one lead mine (another is located near the border in Canada), routine testing by pediatricians over the past two decades[10] and targeted community screening in villages nearest to lead mines[11,12] have identified very few children with a BLL Ն10 ␮g/dL. Targeted screening of children in communities with municipal water systems exceeding Environmental Protection Agency standards for lead[13,14,15] found only a very small number of children with a BLL Ն10 ␮g/dL

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