Blood Lead Levels In Children Research Articles

House Sparrows as Sentinels of Childhood Lead Exposure.

Our understanding of connections between human and animal health has advanced substantially since the canary was introduced as a sentinel of toxic conditions in coal mines. Nonetheless, the development of wildlife sentinels for monitoring human exposure to toxins has been limited. Here, we capitalized on a three-decade long child blood lead monitoring program to demonstrate that the globally ubiquitous and human commensal house sparrow (Passer domesticus) can be used as a sentinel of human health risks in urban environments impacted by lead mining. We showed that sparrows are a viable proxy for the measurement of blood lead levels in children at a neighborhood scale (0.28 km2). In support of the generalizability of this approach, the blood lead relationship established in our focal mining city enabled us to accurately predict elevated blood lead levels in children from another mining city using only sparrows from the second location. Using lead concentrations and lead isotopic compositions from environmental and biological matrices, we identified shared sources and pathways of lead exposure in sparrows and children, with strong links to contamination from local mining emissions. Our findings showed how human commensal species can be used to identify and predict human health risks over time and space.

Effectiveness of soil remediation intervention in abandoned used lead acid battery (ULAB) recycling sites to reduce lead exposure among the children

Lead (Pb) is a neurotoxin, and children are vulnerable due to their evolving physiology and high-risk behaviours. Soil remediation interventions have proven effective in reducing Pb exposure. The primary objective is to measure the effectiveness of soil remediation at abandoned used lead acid battery (ULAB) recycling sites, nearby household cleaning, and community awareness in reducing blood lead levels (BLLs) in children. Additionally, this study aims to examine associations of Pb exposure with hematological, cardiovascular, renal, immunological, and endocrinological parameters in children aged 0–12 years. This study employs a quasi-experimental design, with abandoned ULAB sites as intervention sites and two control sites in Bangladesh. The intervention includes soil remediation coupled with community education. Data will be collected prior to the intervention and at a 12-month follow-up, including a comprehensive Pb exposure survey and collect environmental, turmeric samples, and blood from the child. Pb concentrations in environmental samples and turmeric samples will be determined using XRF analyser. Child BLL will be measured using Graphite Furnace Atomic Absorption Spectrometry (GF-AAS) and proposed biochemical parameters will be analysed using routine laboratory methods. This study could provide valuable insights for designing targeted interventions in similar settings and mitigating exposure to Pb.

The association between childhood blood lead levels and proximity to airports in Colorado

BackgroundIn October 2023, the U.S. Environmental Protection Agency announced a final endangerment finding that leaded aviation gasoline (avgas) contributes to air pollution that is harmful to public health. This study evaluates the evidence for a link between living in proximity to airports and children’s blood lead levels in Colorado.MethodsWe analyzed the association between childhood blood lead levels (BLLs) and proximity to airport point locations in children tested for lead in Colorado over a 10-year study period (2011–2020) using a correlated random effects model with bootstrapped standard errors (N = 56,002 observations, 47,322 individuals). Along with distance from airport point locations, we identified the number of days sampled children lived downwind of their nearest airport during the 60 days prior to their test date. We also adjusted the model for age, sex, detection limit, test type, sample order, seasonality, time, proximity to lead-releasing facilities, estimated monthly aircraft traffic, and demographic characteristics of the surrounding neighborhood.ResultsOur primary model estimates that living one mile (1.6 km) further from airport point locations decreases mean blood lead levels by 0.068 µg/dL. Additional analysis estimates that living one mile further from airport point locations decreases the odds of having a blood lead level ≥ 3.5 µg/dL by 13.2%.ConclusionOur results suggest that lead emissions from aircraft using leaded avgas have a small but statistically significant effect on the BLLs of children living near airport point locations in Colorado. While the risk from proximity to airports is likely less than the risks associated with deteriorating lead paint and dust, our findings highlight the value of lead testing in children who may be at risk of exposure from all sources, including those who live near airports.

Mapping Blood Lead Levels in China during 1980-2040 with Machine Learning.

Lead poisoning is globally concerning, yet limited testing hinders effective interventions in most countries. We aimed to create annual maps of county-specific blood lead levels in China from 1980 to 2040 using a machine learning model. Blood lead data from China were sourced from 1180 surveys published between 1980 and 2022. Additionally, regional statistical figures for 15 natural and socioeconomic variables were obtained or estimated as predictors. A machine learning model, using the random forest algorithm and 2973 generated samples, was created to predict county-specific blood lead levels in China from 1980 to 2040. Geometric mean blood lead levels in children (i.e., age 14 and under) decreased significantly from 104.4 μg/L in 1993 to an anticipated 40.3 μg/L by 2040. The number exceeding 100 μg/L declined dramatically, yet South Central China remains a hotspot. Lead exposure is similar among different groups, but overall adults and adolescents (i.e., age over 14), females, and rural residents exhibit slightly lower exposure compared to that of children, males, and urban residents, respectively. Our predictions indicated that despite the general reduction, one-fourth of Chinese counties rebounded during 2015-2020. This slower decline might be due to emerging lead sources like smelting and coal combustion; however, the primary factor driving the decline should be the reduction of a persistent source, legacy gasoline-derived lead. Our approach innovatively maps lead exposure without comprehensive surveys.

Identification of high lead exposure locations in Ohio at the census tract scale using a generalizable geospatial hotspot approach.

Lead is a persistent, ubiquitous pollutant whose historical sources have been largely addressed through regulation and voluntary actions. The United States (U.S.) has achieved significant decreases in children's blood lead levels (BLL) over the past 40 years; however, there is no known safe level of Pb exposure. Some communities continue to be disproportionately impacted by exposure to Pb, including Black children and families living in older homes. To identify Ohio (OH) census tracts with children exposed to Pb and evaluate potential exposure determinants. We obtained individual children's blood Pb data from 2005-2018 in OH. The percent of children with elevated BLL (EBLL) was calculated for OH census tracts using three blood Pb reference values (3.5, 5, and 10 µg/dL). Getis-Ord Gi* geospatial hotspot or top 20th percentile methodologies were then applied to identify "hotspots." Findings across multiple time periods and blood Pb reference values were evaluated and compared with existing Pb exposure indices and models. Consistency was observed across different blood Pb reference values, with the main hotspots identified at 3.5 µg/dL, also identified at 5 and 10 µg/dL. Substantial gains in public health were demonstrated, with the biggest decreases in the number of census tracts with EBLL observed between 2008-2010 and 2011-2013. Across OH, 355 census tracts (of 2850) were identified as hotspots across 17 locations, with the majority in the most populated cites. Generally, old housing and sociodemographic factors were indicators of these EBLL hotspots. A smaller number of hotspots were not associated with these exposure determinants. Variables of race, income, and education level were all strong predictors of hotspots. The Getis-Ord Gi* geospatial hotspot analysis can inform local investigations into potential Pb exposures for children living in OH. The successful application of a generalizable childhood blood Pb methodology at the census tract scale provides results that are more readily actionable. The moderate agreement of the measured blood Pb results with public Pb indices provide confidence that these indices can be used in the absence of available blood Pb surveillance data. While not a replacement for universal blood Pb testing, a consistent approach can be applied to identify areas where Pb exposure may be problematic.

Biomonitoring of lead in blood of children living in a former mining area in Lower Saxony, Germany

Environmental exposure to lead substantially decreased over the past decades. However, soil of former mining areas still contains high lead levels. We therefore performed a biomonitoring study among children living in two former mining communities in Lower Saxony, Germany. In these communities, soil contains lead levels of 1000 to 30,000 mg/kg. Overall, 75 children (6–10 years of age) attending the two primary schools of the study area took part in the study. Parents completed a short questionnaire on sociodemographics, and children provided capillary whole blood samples. We analysed lead using inductively coupled plasma tandem mass spectrometer. We compared the results to current German (20 μg/l for boys, 15 μg/l for girls) and US (35 μg/l) reference values. Potential associations between questionnaire information and lead results were tested using lead as continuous outcome and using lead dichotomized at the reference values. Finally, we analysed spatial patterns of elevated biomonitoring results. Of all children, 48% exceeded the German reference values for lead (5% expected) and 8% the US reference value (2.5% expected). Children 6–8 years of age were more likely to exceed German reference values (63%) than 9–10 year old children were (32%; pFisher = 0.01). No other questionnaire information was statistically significantly associated with biomonitoring results. Additionally, we did not find any indication of spatial clustering. In conclusion, we observed elevated blood lead levels in primary school children living in a former mining area. In the next step, exposure pathways need to be identified to implement effective public health measures.

United States house dust Pb concentrations are influenced by soil, paint, and house age: insights from a national survey.

Lead (Pb) in house dust contributes significantly to blood lead levels (BLLs) in children which may result in dire health consequences. Assessment of house dust Pb in the United States, relationships with Pb in soil and paint, and residential factors influencing Pb concentrations are essential to probing drivers of house dust Pb exposure. Pb concentrations in vacuum-collected house dust are characterized across 346 homes participating in the American Health Homes Survey II (AHHS II), a US survey (2018-2019) evaluating residential Pb hazards. Connections between house dust Pb and soil Pb, paint Pb, and other residential factors are evaluated, and dust Pb concentration data are compared to paired loading data to understand Pb hazard standard implications. Mean and median vacuum dust Pb concentrations were 124 µg Pb g-1 and 34 µg Pb g-1, respectively. Vacuum-collected dust concentrations and dust wipe Pb loading rates were significantly correlated within homes (α < 0.001; r ≥ 0.4). At least one wipe sample exceeded current house dust Pb loading hazard standards (10 µg ft-2 or 100 µg Pb ft-2 for floors and windowsills, respectively) in 75 of 346 homes (22%). House dust Pb concentrations were correlated with soil Pb (r = 0.64) and Pb paint (r = 0.57). Soil Pb and paint Pb were also correlated (r = 0.6). The AHHS II provides a window into the current state of Pb in and around residences. We evaluated the relationship between house dust Pb concentrations and two common residential Pb sources: soil and Pb-based paint. Here, we identify relationships between Pb concentrations from vacuum-collected dust and paired Pb wipe loading data, enabling dust Pb concentrations to be evaluated in the context of hazard standards. This relationship, along with direct ties to Pb in soil and interior/exterior paint, provides a comprehensive assessment of dust Pb for US homes, crucial for formulating effective strategies to mitigate Pb exposure risks in households.

How Chicago's Past Resulted in Disproportionate Lead Poisoning of Minority Children of the Present: A Narrative Review.

Chicago's lead problem has been shown to disproportionately affect populations of color and lower socioeconomic status (SES). The disproportionate effects on low-income areas and communities of color can be traced back to several key decisions in Chicago's history. A search of the National Library of Medicine's MEDLINE/PubMed as well as Google, and Google Scholar was performed to find all articles relating to lead poisoning in Chicago, lead utilization, Chicago's municipal and political history, and lead physiology between May 2020 and May 2023. Additionally, several studies and textbooks were reviewed regarding the latest advancements in lead poisoning. The study identified several key political moves over the course of Chicago's history that have resulted in disproportionate toxicity in minority populations and those of lower SES. Lead is more readily absorbed in the pediatric population. Additionally, prior regulations had published acceptable blood lead levels (BLLs) in children, but more recent evidence indicates a myriad of detrimental effects in BLLs below that cutoff. There is substantial evidence to suggest that there is no acceptable BLL. Lead toxicity is generally improving nationally but there still exists a considerable need for improvement. Programs should be expanded to ensure that individuals living in communities most at risk of lead exposure have the means to both, replace lead-contaminated infrastructure, and to be able to supply these communities with affordable housing. From a physician and clinician standpoint, knowing the increased risk of lead poisoning in these populations should prompt earlier testing.

Effect of Environmental and Socioeconomic Factors on Increased Early Childhood Blood Lead Levels: A Case Study in Chicago.

This study analyzes the prevalence of elevated blood lead levels (BLLs) in children across Chicagoland zip codes from 2019 to 2021, linking them to socioeconomic, environmental, and racial factors. Wilcoxon tests and generalized additive model (GAM) regressions identified economic hardship, reflected in per capita income and unemployment rates, as a significant contributor to increased lead poisoning (LP) rates. Additionally, LP rates correlate with the average age of buildings, particularly post the 1978 lead paint ban, illustrating policy impacts on health outcomes. The study further explores the novel area of land surface temperature (LST) effects on LP, finding that higher nighttime LST, indicative of urban heat island effects, correlates with increased LP. This finding gains additional significance in the context of anthropogenic climate change. When these factors are combined with the ongoing expansion of urban territories, a significant risk exists of escalating LP rates on a global scale. Racial disparity analysis revealed that Black and Hispanic/Latino populations face higher LP rates, primarily due to unemployment and older housing. The study underscores the necessity for targeted public health strategies to address these disparities, emphasizing the need for interventions that cater to the unique challenges of these at-risk communities.

IEUBK Modeling of Children's Blood Lead Levels in Homes Served by Private Domestic Wells in Three Illinois Counties.

Lead is known to impair neurocognitive development in children. Drinking water is routinely monitored for lead content in municipal systems, but private well owners are not required to test for lead. The lack of testing poses a risk of lead exposure and resulting health effects to rural children. In three Illinois counties, we conducted a cross-sectional study (n = 151 homes) examining water lead levels (WLLs), water consumption, and water treatment status to assess risk of lead exposure among residents using private water wells. Since blood lead levels (BLLs) were not available, EPA's Integrated Exposure Uptake Biokinetic (IEUBK) modeling was used to estimate the incremental contribution of WLL to BLL, holding all other sources of lead at their default values. Nearly half (48.3%) of stagnant water samples contained measurable lead ranging from 0.79 to 76.2 µg/L (median= 0.537 µg/L). IEUBK modeling showed BLLs rose from 0.3 to 0.4 µg/dL when WLLs rose from 0.54 µg/L (the tenth percentile) to 4.88 µg/L (the 90th percentile). Based on IEUBK modeling, 18% of children with a WLL at the 10th percentile would have a BLL above 3.5 µg/dL compared to 27.4% of those with a WLL at the 90th percentile. These findings suggest that the consumption of unfiltered well water likely results in increased blood lead levels in children.

Effectiveness of educational interventions for the prevention of lead poisoning in children: a systematic review.

Childhood exposure to lead has severe health consequences including long-term physical, behavioral, and learning problems. Lead poisoning often occurs in the home and persists as a form of environmental injustice, disparately impacting certain children based on factors such as socioeconomic status, immigration status, and race. Because abatement is costly, many prevention programs rely on educational interventions. We conducted a systematic review to assess the effectiveness of educational interventions on reducing blood lead levels (BLL) in children. Following PRISMA-P guidelines, a librarian-guided search strategy incorporated database-specific subject headings and keywords related to lead poisoning and education, and encompassed four databases: Ovid MEDLINE, Scopus, Web of Science Core Collection and CINAHL. Two reviewers screened the results for those that met inclusion criteria (original research, study population of children under 18 years, inclusion of an educational intervention, outcome of BLL). We screened the titles of 2,062 non-duplicate studies, the abstracts of 78 studies, and full texts of 23 articles, resulting in 17 articles that met eligibility criteria. Thirteen studies used multi-pronged interventions, which precluded comprehensive assessment of the effectiveness of the educational component. Interventions that had success in lowering BLL included some notable elements: longevity of intervention, consideration of culture and ethnicity; use of a community or home-based approach; and provision of supplies or assistance with cleaning. Of the four of studies that used solely educational interventions, three were successful in reducing BLL. Among the 12 studies that used a control group, six found their interventions to be successful in reducing BLL. This review found that educational interventions, either alone or as part of a multi-pronged approach, do not consistently reduce BLL in children. However, educational interventions may decrease severity of lead poisoning in children when more robust interventions are not feasible.

Firearm-Related Lead Exposure and Child Lead Levels in the United States, 2012-2018

ObjectiveTo determine if firearm ownership is positively related to elevated child lead levels at a state-level, even when accounting for other sources of lead. Study designFor this cross-sectional ecological study, we investigated whether household firearm ownership rates (a proxy for firearm-related lead exposure) was associated with the prevalence of elevated child blood lead levels in 44 US States between 2012 and 2018. To account for potential confounding, we adjusted for other known lead exposures, poverty rate, population density, race, and calendar year. To address missing data, we used multiple imputation by chained equations. ResultsPrevalence of elevated child blood lead positively correlated with household firearm ownership and established predictors of lead exposure. In fully adjusted negative binomial regression models, child blood lead was positively associated with household firearm ownership and older housing; each interquartile range (14%) increase in household firearm ownership rate was associated with a 41% higher prevalence of childhood elevated blood lead (prevalence ratio: 1.41, 95% CI: 1.11-1.79). ConclusionThese data provide state-level evidence that firearms may be an important source of child lead exposure. More research is needed to substantiate this relationship and identify modifiable pathways of exposure at the individual level.

Lead exposure in Chinese children: Urbanization lowers children's blood lead levels (BLLs)

Lead is a toxic metal that can pose a huge threat to children's health. China has experienced rapid urbanization since the reform in 1978; however, there has been no examination of the potential influence of this urbanization on children's blood lead levels (BLLs). This study is the initial investigation to explore the correlation between urbanization and BLLs in Chinese children. Five windows of time are considered: pre-2000, 2001–2005, 2006–2010, 2011–2015 and 2016–2021. The results show that urbanization affected lead distribution in urban soil and agricultural soil during the above periods, especially in northern China. The higher non-carcinogenic risk of lead for children is consistent with the lead pollution in soil (3 < Igeo ≤ 4). Urban children's BLLs are slightly higher than those of rural children in 2001–2010, but rural children's BLLs in 2011–2021 are higher than those of urban children during China's urbanization. The areas of rural decline and the areas of urban growth increased across all the window periods. However, the BLLs decrease in all rural and urban areas during all window periods, especially in urban areas. Children's BLLs have a significantly negative correlation with urban areas (p < 0.01). Therefore, China's urbanization has a significant effect on the decrease in children's BLLs. The significance of this study is to provide a fresh perspective and innovative strategy for policymaking in order to reduce children's BLLs and prevent lead exposure. This can be achieved by transforming their external living environment from a rural lifestyle to an urban one, while also ensuring access to well education and maintaining a balanced nutrient intake.

Blood lead levels and math learning in first year of school: An association for concern

Lead is a well-known neurotoxicant that continues to affect children's cognition and behavior. With the aim to examine the associations of lead exposure with math performance in children at the beginning of formal schooling, we conducted a cross-sectional study of first-grade students from 11 schools in Montevideo, Uruguay. Math abilities were assessed with tests from the Batería III Woodcock-Muñoz (Calculation, Math Facts Fluency, Applied Problems, Math Calculation Skills and Broad Maths). Separate generalized linear models (GLM) tested the association of blood lead level (BLL) and each math ability, adjusting for key covariates including age and sex, maternal education, household assets and Home Observation for Measurement of the Environment Inventory score. In a complete-case of 252 first-grade students (age 67–105 months, 45% girls), mean ± SD blood lead level was 4.0 ± 2.2 μg/dL. Covariate-adjusted logistic models were used to examine the association between childhood BLLs and the odds of low math performance. BLL was negatively associated with scores on the Calculation test (β (95% CI): −0.18 (−0.33, −0.03)), Math Calculation Skills (−1.26 (−2.26, −0.25)), and Broad Maths cluster scores (−0.88 (−1.55, −0.21)). Similarly, performance on the Calculation test, as well as cluster scores for Broad Maths and Math Calculation Skills differed between children with BLLs <5 and ≥ 5 μg/dL (p < 0.01), being lower in children with higher BLLs. Finally, considering the likelihood of low test performance, each 1 μg/dL higher B–Pb was related to 27% higher likelihood for Maths Facts Fluency, 30% for Broad Math and Math Calculation Skills, and 31% for Calculation (p < 0.05). These results suggest that lead exposure is negatively associated with several basic skills that are key to math learning. These findings further suggest that the cognitive deficits related to lead exposure impact student achievement at very early stages of formal education.

Secular trends in blood lead concentrations of school-age children in Montevideo, Uruguay from 2009 to 2019

Lead exposure continues to be a public health problem globally, yet very few countries perform systematic biomonitoring or surveillance of children's blood lead levels (BLLs). Secular trends in children's BLLs have not been well characterized outside North America and Europe. In 2009–19, we conducted a series of non-representative cross-sectional surveys in Montevideo, Uruguay, enrolling children living in areas of the city with known or suspected lead contamination. Lead was measured with atomic absorption spectrometry on fasting venous blood samples. Of the 856 children representing independent (non-sibling) observations, 759 had BLL measures. Other missing data were imputed. Using linear and logistic regression models, we estimated the covariate-adjusted year to year difference in mean BLL and the likelihood of having BLL ≥5 and BLL ≥3.5 μg/dL. At the start of the study, mean ± SD BLL was 4.8 ± 2.6 μg/dL, and at the end 1.4 ± 1.4 μg/dL. The prevalence of BLL ≥5 and BLL ≥3.5 μg/dL also differed markedly between 2009 and 2019 (30.8% vs. 2.7% and 53.8% vs. 5.8%). Similarly, where 80.8% of children had BLL ≥2 μg/dL in 2011, in 2019 that number was 19.3%. The estimated year to year difference in BLL was ∼0.3 μg/dL. Despite this progress, pediatric lead exposure remains a problem in Montevideo. In years 2015–19, between 19 and 48% of school children had BLL ≥2 μg/dL, a level at which adverse neurobehavioral outcomes continue to be reported in the literature. Continued prevention and risk-reduction efforts are needed in Montevideo, including systematic surveillance of BLLs in all children.

Impact of the COVID-19 Pandemic on Childhood Lead Testing and Blood Lead Levels

ObjectiveTo evaluate the effect of the COVID-19 pandemic on childhood lead testing and blood lead levels. MethodsA retrospective analysis of lead tests and results was performed across 3 urban medical centers during the pre-COVID-19 (March 10, 2019–March 9, 2020) and COVID-19 (March 10, 2020–March 10, 2022) periods. Interrupted time series analysis with quasi-Poisson regression was used to evaluate changes in lead testing between study periods. The relationship between sociodemographic features with detectable (≧2 µg/dL) and elevated (≧3.5 µg/dL) blood lead levels (BLLs) was assessed with multivariable logistic regression. ResultsAmong a total of 16,364 lead tests across 10,362 patients, weekly testing rates significantly decreased during COVID-19 (relative risk (RR) 0.64, 95% (confidence interval) CI 0.53–0.78). Census tracts with the greatest proportion of pre-1950s housing had a stronger association with detectable BLLs during the COVID-19 period (pre-COVID-19 adjusted odds ratio (aOR) 1.73, 95% CI 1.35–2.20; aOR 2.58, 95% CI 2.13–3.12; interaction P value .014). When limited to 1 year following COVID-19 (March 10, 2020–March 10, 2021), the association between both elevated BLLs (pre-COVID-19: aOR 1.49, 95% CI 0.87–2.53; COVID-19: aOR 3.51, 95% CI 1.98–6.25; interaction P value .032) and detectable BLLs with pre-1950s housing were greater during the COVID-19 period (pre-COVID-19: aOR 1.73, 95% CI 1.35–2.20; COVID-19: aOR 2.56, 95% CI 1.95–3.34; interaction P value .034). ConclusionsThe COVID-19 pandemic led to a significant reduction in lead surveillance and magnified the effect of known risk factors for lead exposure. Concerted clinical, public health, and community advocacy are needed to address care gaps and excess cases of lead poisoning.

Reductions in Children's Blood Lead Levels from a Drinking-Water Intervention in Madagascar, Sub-Saharan Africa.

One in three children globally is estimated to have blood lead levels (BLL) at or above the BLL reference value of 5 μg/dL with increased burden falling on low- and middle-income countries (LMIC). Within developed countries, aqueous lead is the predominant exposure route. However, aqueous lead exposure is rarely examined in the LMIC, leaving a gap in the literature that ignores a potentially significant route of exposure. Furthermore, limited lead-based remediation efforts around consumer products have been examined. This study investigates the importance of lead exposure from the water supply through a case study in Toamasina, Madagascar. The project measured aqueous lead and BLL of children pre- and postremediation efforts (i.e., removal of leaded pump components in hand pumps) to verify the impact of aqueous lead exposure within this community. Removal of the leaded pump components (i.e., piston and foot valves) and replacement with nonleaded components decreased aqueous lead levels below the World Health Organization provisional guideline of 10 μg/L in all but 4% of pumps tested. Measured BLL concentrations indicated a statistically significant decrease in BLL from pre- to postremediation. Furthermore, the remediation resulted in a decrease in BLL for 87% of children with the greatest changes in BLL observed for children with the highest preremediation concentrations. These findings point to a need for greater consideration of lead in drinking and cooking waters as an important exposure route in LMIC.

Making the case for lead safe housing: Downstream effects of lead exposure on outcomes for children and youth

Lead based paint is a predominate source of lead exposure in children, which has a documented negative effect on their health and development. Despite public health efforts, the housing stock in disinvested neighborhoods in many cities continues to present significant risk of childhood lead exposure. In this article, we describe how a multi-agency integrated data system was used to document the impact of lead exposure on indicators of child and youth development as recorded in educational and human service systems. By tracking administrative data for two cohorts of Cleveland, Ohio children from birth to early adulthood and using rigorous matching methods to reduce confounders when comparing those with and without elevated blood lead levels, we document negative effects on developmental, behavioral and socio-economic outcomes due to early childhood lead exposure. The magnitude of disparities between individuals who had elevated blood lead levels (≥5 μg/dL) in early childhood, compared to their matched counterparts, is in the ranges of 20–40%. The analysis is framed by clarifying the context, assumptions and limitations associated with the use of administrative data. This type of information has been useful in illuminating the burden of lead exposure for children, families and youth serving agencies and engaging public officials, landlords and residents in initiatives to bring housing up to lead safe standards.

Prevalence of elevated blood lead level in children with global developmental delay and its relation with parental and child attributes

Background: Lead, a potential neurotoxin, is found in soil, water and air as a result of its non-biodegradable nature. Common sources of lead toxicity in children are household paints, leaded pipes for water supply, canned food, coloured toys, herbal/folk remedies and electronic wastes. Along with this, other child and parental attributes have been found to contribute to elevated blood lead level (EBLL). Objectives were to estimate the prevalence and risk factors of EBLL in children with global developmental delay (GDD). Methods: This hospital based cross sectional study was conducted between October 2019 and October 2021 at department of paediatrics of JNMCH, AMU, Aligarh. Data regarding clinical and sociodemographic characteristics as well as parental attributes was collected and entered on pre-designed proforma. Results: Among 94 children with GDD mean BLL was found to be 6.72±6.46 mcg/dl and in their mothers it was 6.74±6.46 mcg/dl (p=0.984). A high prevalence of EBLL (&gt;5 mcg/dl) in children with GDD (53.20%) and their mothers (49.3%) was noted. Various child and parental attributes were identified as potential sources of exposure to lead. Conclusions: A high prevalence of EBLL in children with GDD in our study area might also suggest higher exposure from environmental sources such as soil, water, electronic waste, lead acid batteries, etc. For countries like ours which is rapidly undergoing industrialisation, these potential sources need to be identified promptly and swift action in this regard is needed in addition to preventive measures at personal and family levels.

B-328 Analytical Performance of a Screening Test for Lead Using Dried Blood Spots and ICP-MS

Abstract Introduction There is no safe blood lead levels (BLL) in children and exposure can cause irreversible neurological harm. In 2021, the CDC decreased the blood lead reference value (BLRV) to 3.5 ug/dL from 5.0 ug/dL, based on the 97.5th percentile of BLL among US children under 5 years of age. Despite this, lead poisoning disproportionately affects Black children, those below poverty levels, and living in houses built before 1978. The American Academy of Pediatrics recommends targeted screening for BLL in children aged 12–24 months living in high prevalence areas. Children enrolled in Medicaid also require screening by 24 months of age. Only one-third of children who require screening receive it and lead screening declined by &amp;gt;50% during the COVD-19 pandemic. Quality improvement strategies have included electronic health record alerts and point of care testing. To improve screening rates in our pediatric population, we developed a screening method utilizing dried blood spot (DBS) cards. This study aimed to validate the accuracy and precision of this screening method with emphasis on the performance around the BLRV cut-offs, which would be used to determine the need to follow up with a confirmatory venous lead test. Methods The method was calibrated using certified reference material traceable to NIST SRM 3128 (VHG labs, Manchester, NH, USA) in whole blood. The calibrators, controls and patient samples were spotted onto Whatman 903 cards. A 6 mm filter paper disc in extraction buffer was vortexed, allowed to sit at room temperature for 30 min and centrifuged. The samples were analyzed on the Thermo Fisher iCAP RQ and TQ (Whaltman, MA) in kinetic energy discrimination mode. The assay has a linear range of 1–100 µg/dL, and the recovery ranged from 92%–102%. We evaluated this method for reproducibility, and accuracy across the measurement range. In this study, we focused on the reproducibility and accuracy of DBS at lead concentrations around the BLRV cut-offs. We used in 2 samples spiked with NIST CRM 3128 (Inorganic Ventures, Christiansburg, VA, USA) analyzed 10 times over 3 days and 13 leftover patient samples run over at least 5 days. The total allowable error was 2 µg/dL or 10%. Results In two samples spiked to BLL of 3.5 and 3.9 µg/dL, interday precision (n = 10) ranged from 3.4% to 17.4% (SD 0.1–0.7) in samples run for 3 days. Removal of an apparent outlier decreased the %CV ranged observed to &amp;lt;8.5%. The average bias for each day ranged from 0.1 to 0.6 µg/dL. In 13 patient samples with concentrations around the BLRV ranging from 1.4 to 5.8 µg/dL, the coefficient of variation (CV) ranged from 0.2% to 32% with the largest SD at 0.8 µg/dL. The average bias for this sample set was -0.3 (11.7%). Conclusion The assay’s analytical performance is sufficient for screening purposes, but the clinical performance and the impact of introducing this test to enhance screening rates during 1 and 2 years well visits need to be evaluated further.