Elevated Blood Lead Levels Research Articles

Elevated serum lead levels in neonates born to mothers suffering from opiate use disorder.

This study was performed to investigate lead levels in neonates born to the mothers suffering from opiate use disorder (OUD) and the association of lead levels with the Apgar score. The present cross-sectional study included 56neonates who were referred to the neonatal ward of Amir-Al Momenin Hospital, Zabol. The neonates were divided into two groups: the neonates whose mothers suffered OUD and the control group. Data were collected using aresearcher-prepared questionnaire, and blood lead level was determined using the atomic absorption method. Data were statistically analyzed. In all, 56neonates (28from OUD mothers and 28from the control mothers) were included in this study. Among the women with OUD, 16 (57%) used inhaled opium, while12 (43%) consumed opium orally. There was asignificant difference regarding Apgar score (9.76 ± 2.11 versus. 7.11 ± 4.21; p = 0.02) and the neonate's blood lead level (2.33 ± 1.3 µg/dl versus 7.33 ± 5.9 µg/dl) between the control and OUD groups (p < 0.001). The odds ratio of abnormally elevated blood lead level rose with increasing duration of maternal opiate disorder for opiate usage durations of 3to 5years (adjusted odds ratio [OR] 42.82, 95% confidence interval [CI] 3.27-561, p = 0.004) and > 5years (adjusted OR 45.5, 95% CI 2.97-698, p = 0.006). The results of this study suggested asignificant relationship between maternal opium consumption during pregnancy and neonatal serum lead levels, as well as decreased neonatal Apgar score.

Estimating the Effects of Soil Remediation on Children's Blood Lead near a Former Lead Smelter in Omaha, Nebraska, USA.

Background:Lead exposures from legacy sources threaten children’s health. Soil in Omaha, Nebraska, was contaminated by emissions from a lead smelter and refinery. The U.S. Environmental Protection Agency excavated and replaced contaminated soil at the Omaha Lead Superfund Site between 1999 and 2016.Objectives:The goal of this study was to assess the association of soil lead level (SLL) and soil remediation status with blood lead levels (BLLs) in children living near or on the site.Methods:We linked information on SLL at residential properties with children’s BLLs and assigned remediation status to children’s BLL measurements based on whether their measurements occurred during residence at remediated or unremediated properties. We examined the association of SLL and remediation status with elevated BLL (EBLL). We distinguished the roles of temporal trend and the intervention with time-by-intervention-status interaction contrasts. All analyses estimated odds ratios (ORs) with a generalized estimating equations approach to ensure robustness under the complex correlations among BLL measurements. All analyses controlled for relevant covariates including children’s characteristics.Results:EBLL () was associated with both residential SLL [e.g., ; 95% confidence interval (CI): 1.83, 2.19; vs. ] and neighborhood SLL [e.g., (95% CI: 1.62, 2.11; vs. )] before remediation but only with neighborhood SLL after remediation. The odds of EBLL were higher before remediation [OR 1.52 (95% CI: 1.34, 1.72)]. Similarly, EBLL was positively associated with preremediation status in our interaction analysis [interaction (95%CI: 1.02, 1.37)].Discussion:Residential and neighborhood SLLs were important predictors of EBLLs in children residing near or on this Superfund site. Neighborhood SLL remained a strong predictor following remediation. Our data analyses showed the benefit of soil remediation. Results from the interaction analyses should be interpreted cautiously due to imperfect correspondence of remediation times between remediation and comparison groups. https://doi.org/10.1289/EHP8657

Spatial Analysis and Lead-Risk Assessment of Philadelphia, USA.

Childhood lead poisoning is an issue that continues to plague major U.S. cities. Despite efforts by the Philadelphia Department of Public Health to curtail systemic childhood lead poisoning, children continue to be identified with elevated blood lead levels. The persistence of elevated blood lead levels in children is concerning because lead poisoning has been linked to decreases in academic achievement and IQ, with associated repercussions for entire communities. This paper reports the results of an analysis of the spatial distribution of houses with lead paint (i.e., pre‐1978), demolitions, and occurrence of historic smelters, in West and North Philadelphia, relative to elevated blood lead level data, to determine which lead sources act as primary lead‐risk factors. The presence of lead paint in homes and the number of demolitions of older properties were found to have the highest correlations to elevated blood lead levels for children in Philadelphia. Using lead‐risk factors including lead paint, housing code violations, demolitions, and owner‐occupied housing units, a lead‐risk assessment was performed at the census tract level to identify future soil sampling sites and high‐risk neighborhoods in Philadelphia. These sites of high risk for lead exposure, and in particular the census tracts 175 and 172, should be prioritized for lead poisoning prevention initiatives.

Abstract P104: High Lead Levels Associated With Elevated Blood Pressure In Haiti: A Warning Sign

Introduction: Cardiovascular disease is the leading cause of death in Haiti and many low-middle income countries. Environmental lead exposure is associated with higher blood pressure (BP) and cardiovascular disease mortality in high income countries but has not been systematically evaluated in lower income countries where 6.5 billion people reside. Hypothesis: We hypothesized higher lead levels would be associated with higher BP in Haiti. Methods: Blood lead levels (BLLs) were measured among 2,257 participants ≥18 years enrolled in a population-based longitudinal cohort study in Port-au-Prince (Haiti Cardiovascular Disease Cohort Study). BLL screening was conducted using LeadCare II (detection limit ≥3.3 μg/dL). BLLs below detection were imputed. Associations between BLLs (quartiles) and systolic BP (SBP) and diastolic BP (DBP) were assessed, adjusting for age, sex, obesity, smoking, physical activity, and income. BLLs were also categorized as ≥5 versus &lt;5 μg/dL. Results: The median age was 40 years; 62.6% were female. The geometric mean BLL was 4.60 μg/dL, 67.3% had detectable BLLs &gt;3.3 μg/dL, and 40.9% had elevated BLLs ≥5 μg/dL. BLLs in quartile four (≥6.5 μg/dL) in both unadjusted and adjusted analyses were associated with higher SBP (adjusted 3.02 mmHg; 95%CI 0.80, 5.25) and DBP (adjusted 2.19 mmHg; 95%CI 0.70, 3.67). BLL ≥5 μg/dL were associated with a higher SBP (2.21 mmHg; 95%CI 0.15, 4.26) and DBP (1.50 mmHg; 95%CI 0.20, 2.81) in unadjusted analysis. After adjustment there was no difference in SBP (1.41; 95%CI -0.25, 3.09) and 1.15 mmHg (95%CI 0.01, 2.30) higher DBP. Conclusions: Widespread environmental lead exposure is evident in urban Haiti, with higher BLLs associated with higher SBP and DBP. Lead is a modifiable pollutant in low-income countries that warrants urgent public health remediation.

Lead Levels in Spices From Market Basket and Home Lead Investigation Samples in North Carolina.

Lead investigators in North Carolina found evidence that contaminated spices may contribute to children's elevated blood lead levels. We compared lead levels in samples of spices and other consumable products by country of purchase to inform consumer safety interventions and regulations. From February 1, 2011, through October 22, 2020, North Carolina lead investigators sampled spices and other consumable products from 103 homes of children with confirmed elevated blood lead levels. In 2017, the study team purchased 50 products frequently sampled during lead investigations, as a "market basket" sample, from local stores in or near Raleigh, North Carolina. The State Laboratory of Public Health analyzed 423 product samples using mass spectrometry. We extracted environmental sample results from lead investigations from the North Carolina Electronic Lead Surveillance System. The median market basket lead result was 0.07 mg/kg (SD = 0.17); the maximum lead result was 0.88 mg/kg. The median home lead investigation sample result was 0.26 mg/kg (SD = 489.44); the maximum lead result was 6504.00 mg/kg in turmeric purchased in India. Among all samples, products purchased in India had more than triple the median lead levels (0.71 mg/kg) of those purchased in the United States (0.19 mg/kg). Purchasing spices in the United States is an action that consumers can take that may reduce their lead poisoning risk. Regulatory agencies should consider a lead limit of <1 mg/kg as attainable for spices sold in US stores and for ingredients of any foods that may be consumed by children.

Child Lead Screening Behaviors and Health Outcomes Following the Flint Water Crisis.

There is little research on lead (Pb) screening behaviors and outcomes and possible health sequelae of children in Flint, Michigan in the years following the city's 2014 water crisis, which included widespread tap water contamination with elevated levels of heavy metals and other environmental contaminants. Between June and November 2019, we collected and analyzed cross-sectional data on Flint children's demographics and self-report of screenings of blood lead levels (BLLs) and results and various potential water contamination-related health symptoms andoutcomes. We calculated descriptive statistics to summarize the prevalence of health outcomes and screenings in children, and fit multivariable models using generalized estimating equations to characterize the association between baseline traits and health symptoms and outcomes in children. A total of 244 children (mean age 8.6 ± 4.8) were included in the analysis. Overall, 76.6% of the children were reported to have been screened for elevated BLLs after the water source switch. In total, after the water source switch, 25.0% of children were reported as having clinician-diagnosed elevated BLLs. Overall, 43.9% of children experienced hyperactivity, 39.3% had emotional agitation, 29.1% had comprehension issues/learning delays, while 38.9% of children had skin rashes and 10.7% experienced hair loss. A child having elevated BLLs also significantlyincreased the odds of experiencing adverse cognitive/behavioral outcomes (comprehension issues/learning delays OR = 4.0, hyperactivity OR = 6.6, emotional agitation OR = 3.5). Child BLL screening following the crisis initiation was moderate, and BLLs and potential water contamination-related morbidity outcomes appeared heightened. Further research is needed to contextualize epidemiologic factors contributing to BLL screening patterns and results and the potential water contamination-associated sequelae observed here.

Blood Lead Levels in Children Living Near Lead Smelting Zone: A Pilot Field Study

Introduction: Children are most susceptible to lead toxicity. Exposure to lead in the environment still exists in various pockets of urban cities due to continued practices of using lead in jewellery making, paints, battery smelting and in cosmetics. Aim: To evaluate Blood Lead Level (BLL) and its association with haemoglobin, Red Blood Corpuscle (RBC) indices and bone parameters (vitamin D, parathyroid hormone, calcium, phosphorus, and Alkaline Phosphatase (ALP) in children residing near lead battery smelting units of Kolkata. Materials and Methods: This was a cross-sectional field-based study carried out by Institute of Child Health, Kolkata. A camp was organised in the month of August 2015 at a known major cluster of secondary lead smelting area ward no. 66 in the Kolkata metropolitan district. A total of 45 camp attending children were enrolled. BLL was measured using graphite furnace atomic absorption spectrometry, and association with haematological and bone parameters were evaluated. Results: Mean age of the participants was 5.6±3.3 years, and mean BLL was 3.7±1.9 μg/dL (range:1.3-8.2). About 35 children were found to have Low BLL&lt;5 μg/dL (LBLL, 2.88±1.08) while 10 had elevated BLL≥5 μg/dL (EBLL, 6.59±0.95) (p&lt;0.0001). Red Cell Distribution Width (RDW) was high (p=0.03) and Mean Corpuscular Volume (MCV) was low (p=0.05) in EBLL group; but there was no significant difference in haemoglobin level, compared to LBLL group. The mean vitamin D level was 15.2±8.7 ng/mL, while 23 (51%) were severely deficient without concomitant rise in parathyroid hormone (mean, 37.9±0.7 pg/mL). Calcium, phosphorous and ALP were within normal reference range. None of the bone parameters showed any correlation with BLL. Conclusion: Overall, 22% children of the cohort had elevated BLL, beyond the permissible safety limit of 5 μg/dL but within 10 µg/dL. Mildly elevated BLL relate to iron deficient hematopoiesis (increased RDW and low MCV) without any apparent affection of bone metabolism.

Risk-Factor Based Lead Screening and Correlation with Blood Lead Levels in Pregnancy.

Lead exposure has devastating neurologic consequences for children and may begin in utero. The American College of Obstetricians and Gynecologists recommends prenatal lead screening using a risk factor-based approach rather than universal blood testing. The clinical utility of this approach has not been studied. We evaluated a risk-factor based questionnaire to detect elevated blood lead levels in pregnancy. We performed a secondary analysis of a cohort of parturients enrolled to evaluate the association of lead with hypertensive disorders of pregnancy. We included participants in this analysis if they had a singleton pregnancy ≥ 34weeks' gestation with blood lead levels recorded. Participants completed a lead risk factor survey modified for pregnancy. We defined elevated blood lead as ≥ 2μg/dL, as this was the clinically reportable level. Of 102 participants enrolled in the cohort, 92 had blood lead measured as part of the study. The vast majority (78%) had 1 or more risk factor for elevated lead using the questionnaire yet none had clinical blood lead testing during routine visits. Only two participants (2.2%) had elevated blood lead levels. The questionnaire had high sensitivity but poor specificity for predicting detectable lead levels (sensitivity 100%, specificity 22%). Prenatal risk-factor based lead screening appears underutilized in practice and does not adequately discriminate between those with and without elevated blood levels. Given the complexity of the risk factor-based approach and underutilization, the benefit and cost-effectiveness of universal lead testing should be further explored.

Declines in Blood Lead Levels Among General Population - China, 2000-2018.

Environmental and occupational lead exposure has generally declined in the past two decades. However, there is no large-scale monitoring of blood lead levels (BLLs) in the Chinese general population. This nationally representative study showed declines of BLLs in all ages of participants; for children aged 3-5 years, down from 78.1 μg/L to 16.9 μg/L, corresponding to 78.4% decrease in the past two decades (2000-2018). Recommendations for elevated BLLs on screening children at high risk now need to be revisited and updated from 100 μg/L to 50 μg/L in guidelines to conform with the substantial declines in China.

Iron deficiency and cognitive impairment in children with low blood lead levels

BackgroundThe relationship between iron deficiency (ID) and children's neurocognitive functions has attracted the interest of the scientific community, particularly among those living at the lead-contaminated sites. Thus, the current paper aims at evaluating the association between ID and neurocognitive performance of school children living in a mining area (CMA) in comparison with a control group (CG). Methodshe study involves 90 school children aged from 6 to 10 years old. A survey was conducted to obtain information on the socio-economic and demographic status of the children. The students underwent cognitive test battery including the Bell Dam Test (BDT) and the Digit Span test (DST). Iron status (IS) was determined by serum iron, ferritin, transferrin, and blood count (CBC). Blood lead levels (BLLs) were measured by the Graphite Furnace Atomic Absorption Spectrophotometer (SAA-FG). ResultsAn ID was observed in 23.3 % of CMA, but it is not statistically different from the CG 21.7 % (p = 0.774). CMA group exhibited elevated BLLs (3.5 ± 1.21 µg/dL) when compared to the CG (2.31 ± 0.95 µg/dL), p = 0.006. Children's performance on the visual attention test (VA) was impaired in both groups. Working memory (WM) abilities were normal. In bivariate analysis, no difference was demonstrated in mean BLLs between the students who adopt the disorganized scanning strategy compared to the others whose method is organized for both CMA (t = − 0.508, p = 0.616) and CG (t = − 0.014, p = 0.989). Multivariate models did not reveal any association between IS and cognitive scores of children in the two groups (p > 005). Nevertheless, daily milk consumption was positively associated to VA skills among CMA. A negative influence of BLLs above the threshold value of 5 µg/dL was determined on children's WM skills. ConclusionOur results suggest that low-level lead exposure did not influence children's visual attention scores but may adversely affect WM abilities if it reaches the threshold value of 5 µg/dL regardless of their IS.

Blood lead concentrations among pediatric patients with abdominal pain: a prospective cross-sectional study

BackgroundLead exposure is one of the most menacing of environmental exposures, particularly in children. Children are more susceptible to the effects of lead which manifest in many organ systems, including interference with mental and motor development. Lead poisoning can cause colicky abdominal pain. In this study, the authors sought to evaluate the prevalence of elevated blood lead level (BLL) and its contributing factors among pediatric patients presenting with abdominal pain. An epidemic of lead poisoning in adults was previously uncovered, and thus a concern for pediatric lead poisoning was raised.MethodsPediatric patients presenting to two pediatric clinics in Tehran with abdominal pain were eligible for enrollment in a descriptive prospective cross-sectional study. A predesigned questionnaire was filled for each patient by their consenting parents. The questionnaire queried demographic information, environmental, social, and other relevant parameters for lead exposure. After completion of the questionnaire, biometrics were obtained, and a blood sample was taken from each patient for measurement of BLL and complete blood count.ResultsA total of 187 patients were enrolled in the study. Of them, almost 20% had BLL ≥ 5 µg/dL. Univariate analysis showed that age (p = 0.002, OR 3.194, CI 95% 1.504–6.783), weight (p = 0.009, OR 2.817, CI 95% 1.266–6.269), height (p = 0.003, OR 3.155, CI 95% 1.443–6.899), and playing with both plastic and cotton toys (p = 0.03, OR 2.796, CI 95% 1.072–7.295) were significant predictors of high BLLs. Maternal level of education correlated with blood lead concentrations (p = 0.048, OR 2.524, CI 95% 1.006–6.331).ConclusionsA clinically significant number of cases of abdominal pain may have high BLLs. Specific attention should be paid to children presenting with abdominal pain, especially due to the detrimental effects of lead on their mental and motor development.

Lead, Soils, and Children: An Ecological Analysis of Lead Contamination in Parks and Elevated Blood Lead Levels in Brooklyn, New York.

Although the prevalence of elevated childhood blood lead levels (BLLs) has been declining, there are still an estimated 500,000 children (1 to 5years) with BLLs above the CDC's reference value (≥ 5μg/dL). The objective of this study was to evaluate the ecological association between soil lead (Pb) concentrations in greenspaces in Brooklyn, NY and elevated BLLs of children aged 1 to 5years old. Soil samples (n = 1504) were collected from a wide variety of parks within 43 neighborhood tabulation areas (NTAs) located in Brooklyn, NY, analyzed with a portable XRF with a subset (n = 350), and also analyzed by ICP-MS. Lead concentrations were right skewed with a mean of 160.4ppm and a median of 113.1ppm. The Pb concentration range spanned three orders of magnitude with most samples (66.7%) ≥ 80ppm and 6.7% of samples ≥ 400ppm. Elevated BLL (≥ 5ug/dL) data on children 1 to 5years were obtained from the New York City Department of Health and Mental Hygiene (2011-2015). Weighted median soil Pb concentrations were calculated for each NTA and stratified into quartiles. The overall median rate of children from 1 to 5years old with BLLs ≥ 5µg/dL was 28.6 per 1000; the median rate was highest (p = 0.070) in the fourth quartile (Pb concentrations ≥ 150ppm) compared to the first quartile (Pb concentrations < 88ppm), 37.2 vs. 28.3 per 1000, respectively. We then used multivariable linear regression to determine the ecological association between BLL rates and soil Pb concentrations. In the final stepwise multivariable regression model, controlling for known risk factors, there was a significant positive association between soil Pb concentrations and increased childhood BLL rates (beta = 0.0008; p = 0.004). Our findings suggest that thereis an ecological association between high soil Pb levels and increased rates of elevated childhood BLLs.

Cake Decorating Luster Dust Associated with Toxic Metal Poisonings - Rhode Island and Missouri, 2018-2019.

During 2018-2019, the Rhode Island Department of Health (RIDOH) and the Missouri Department of Health and Senior Services (DHSS) investigated cases of metal poisonings associated with commercially and home-prepared cakes decorated with products referred to as luster dust. Several types of glitters and dusts, broadly known as luster dust,* for use on prepared foods can be purchased online and in craft and bakery supply stores (1). Decorating foods with luster dust and similar products is a current trend, popularized on television programs, instructional videos, blogs, and in magazine articles.† Some luster dusts are specifically produced with edible ingredients that can be safely consumed. Companies that make edible luster dust are required by law to include a list of ingredients on the label (2). Luster dusts that are safe for consumption are typically marked "edible" on the label. Some luster dusts used as cake decorations are not edible or food grade; labeled as "nontoxic" or "for decorative purposes only," these luster dusts are intended to be removed before consumption (3). RIDOH (2018) and Missouri DHSS (2019), investigated heavy metal poisonings associated with commercially and home-prepared cakes decorated with luster dust after receiving reports of children (aged 1-11 years) who became ill after consuming birthday cake. Cases in Rhode Island were associated with copper ingestion, and the case in Missouri was associated with a child's elevated blood lead level. In Rhode Island, luster dust products that had been used in cake frosting were found to contain high levels of multiple metals.§ These events indicate that increased vigilance by public health departments and further guidance to consumers and bakeries are needed to prevent unintentional poisonings. Labeling indicating that a product is nontoxic does not imply that the product is safe for consumption. Explicit labeling indicating that nonedible products are not safe for human consumption is needed to prevent illness from inappropriate use of inedible products on foods. Educating consumers, commercial bakers, and public health professionals about potential hazards of items used in food preparation is essential to preventing illness and unintentional poisoning from toxic metals and other nonedible ingredients.

Preschool blood lead levels, language competency, and substance use in adolescence

BackgroundElevated lead levels in children are a persistent public health problem, particularly in urban areas in the United States, yet few prospective studies have examined the association of childhood lead levels with substance use in adolescence. ObjectivesTo determine the association of early lead levels with adolescent substance use and whether childhood IQ, language skills, and externalizing (aggressive and disruptive) behavior mediate the association, controlling for confounding biological and environmental factors. MethodsThe participants (N = 265) were a subsample of a prospective birth cohort study on the developmental effects of prenatal cocaine exposure in the Midwest United States. Blood lead levels (BLL) were assessed at age 4, IQ at age 11, language skills and externalizing behavior at age 12, and substance (alcohol, tobacco, marijuana) use and substance use-related problems at age 15. Biologic assays (hair, urine, bloodspots), along with self-report, were utilized to determine adolescent substance use. Path analyses were conducted to examine the direct and indirect associations of BLL with adolescent substance use. ResultsThe children's mean BLL at 4 years of age was 7.07 (SD = 4.12) μg/dL. Approximately 31% of adolescents used tobacco or marijuana, 40% used alcohol, and 23% reported experiencing substance use-related problems at age 15.7 (SD = 0.28). Elevated BLL was related to a higher likelihood of substance use. Childhood language skills fully mediated the relationship of BLL with substance use-related problems. IQ was related to neither substance use nor substance use-related problems. DiscussionElevated BLL in preschool years is a risk factor for adolescent substance use and related problems. Early screening and intervention for language impairment may reduce substance use-related problems.

Blood Lead Level among Children between 8-18 years of Age by Atomic Absorption Spectrophotometry: A Descriptive Cross-sectional Study.

Lead is naturally available toxic heavy metal which is one of the main causes of environmental pollution and produces detrimental effects on health, particularly young children. Lead toxicity has become an emerging global burden of disease varying with the age, socio-economic status, occupation, industrialization, social customs and behaviours. The objective of this study was to find out the baseline blood lead level among children between 8-18 years. A descriptive study was conducted in Gokarneshwor Municipality, Kathmandu with a total of 160 children between 8-18 years of age from 2018 to 2019 after taking ethical approval from Research and Institutional Review Committee (Reference number: 17-074/075). Informed written consent was taken from the principal along with their respective parents and semi structured questionnaires were asked to students. Sample size was calculated and simple random sampling was done. The data was analyzed using Statistical Package for Social Science version 16. Point estimate at 95% Confidence Interval was calculated along with frequency and descriptive statistics. The mean blood lead level of the children was 4.39±7.35 µg/dl. Mean hemoglobin being 12.63g/dl; out of 160 children 30 (18.75%) children had blood lead levels. Children with elevated blood lead level had mean haemoglobin level within normal range (13.05gm/dl), however out of 30 children, 8 (27%) had haemoglobin level below normal. Lead exposure in the children of urban area of Nepal is considerably high as compared to similar studies coducted in similar settings.

Screening for blood lead level in reproductive age group individuals in Kathmandu

Introduction: Elevated blood lead level is associated with serious, often irreversible, health consequences. At present, the safe level of blood lead cannot be ascertained since the emerging data indicate the toxic potential to human organ system at a low level that was previously considered safe. Screening for blood lead level is not in regular practice in Nepal. This study is designed to evaluate the prevalence of detectable blood lead level in reproductive age group of Nepalese population that represents the wide local population. Materials and methods: 170 reproductive age group individual (20 to 49 years) attending Samyak diagnostic Pvt Ltd and Alka IVF and fertility centre for regular health checkup were included in this study for blood lead level analysis. The participants were categorized as normal or sub-fertile. Blood lead level was estimated using anodic stripping voltametry. Results: In total study participants, 28.8% of male and 25.8 % of female had BLL ≥3.0 µg/dL. The minimum detectable blood lead level in both male and female was 3.3 µg/dL while the maximum blood lead level was higher in male (15.5 µg/dL) than in female (8.4 µg/dL). The median blood lead level of the sample population was 3.7(4.8 -6.9) µg/dL. There was no significant difference in blood lead level between gender (p=0.108). Conclusion: It is justifiable to screen for blood lead level in the reproductive age group individual in Nepal.

Individual- and Community-Level Factors Associated With Detectable and Elevated Blood Lead Levels in US Children

No safe level of exposure to lead has been identified. To evaluate individual- and community-level factors associated with detectable and elevated blood lead levels (BLLs) in children. This cross-sectional, retrospective study analyzed deidentified results from blood lead tests performed at a large clinical laboratory from October 1, 2018, to February 29, 2020. Participants were 1 141 441 children younger than 6 years living in all 50 US states and the District of Columbia who underwent blood lead testing during the study period. Children who underwent lead testing of unknown source and those with elevated BLLs who received capillary blood lead testing without confirmatory venous testing were excluded. Individual demographic categories included sex, age, and insurance type; community-level demographic categories included pre-1950s housing, poverty, predominant race and ethnicity, and geographical regions. Proportions of children with detectable (≥1.0 μg/dL) and elevated (≥5.0 μg/dL) BLLs, by exposure category. Of the 1 141 441 children (586 703 boys [51.4%]; mean [SD] age, 2.3 [1.4] years) in the study, more than half of the children tested (576 092 [50.5%; 95% CI, 50.4%-50.6%]) had detectable BLLs, and 21 172 children (1.9% [95% CI, 1.8%-1.9%]) had BLLs of 5.0 μg/dL or more. In multivariable analyses, children with public insurance had greater odds of having detectable BLLs (adjusted odds ratio [AOR], 2.01 [95% CI, 1.99-2.04]) and elevated BLLs (AOR, 1.08 [95% CI, 1.04-1.12]). The proportion of children with detectable and elevated BLLs increased significantly for progressive pre-1950s housing and poverty quintiles (P < .001). The odds of detectable BLLs were significantly higher among children in the highest vs lowest quintile of pre-1950s housing (AOR, 1.65 [95% CI, 1.62-1.68]) and of poverty (AOR, 1.89 [95% CI, 1.86-1.93]). A similar association was found for those with elevated BLLs, with an AOR of 3.06 (95% CI, 2.86-3.27) for the highest vs lowest quintile of pre-1950 housing and 1.99 (95% CI, 1.88-2.11) for the highest quintile of poverty. Children residing in zip codes with predominantly Black non-Hispanic and non-Latinx populations had higher odds of detectable BLLs (AOR, 1.13 [95% CI, 1.11-1.15]) but lower odds for elevated BLL (AOR, 0.83 [95% CI, 0.80-0.88]). This study suggests that, despite progress in reducing pediatric lead exposure, substantial individual- and community-level disparities persist.

Modeling annual elevated blood lead levels among children in Maryland in relation to neighborhood deprivation

Estimating environmental lead exposure using ecologic risk models is an inexpensive strategy to inform public health departments and to develop location-based intervention strategies such as targeted screening and mitigation. Importantly, studies in this area have not assessed temporal and spatio-temporal lead exposure risk trends. Due to lead abatement efforts and targeted screening efforts, it is anticipated that lead exposure risk has decreased over time. However, it is unknown if decreases have occurred, and if the decreases are evenly distributed across neighborhoods. Thus, the purpose of this study was to examine the association between neighborhood deprivation and risk of elevated blood lead levels (EBLLs) in both temporal and spatio-temporal contexts within the US state of Maryland in 2005–2015. To consider the temporal dimension of lead risk, we used a novel extension of Bayesian index models to estimate time-varying neighborhood deprivation indices along with time-varying index effects. The results showed that overall EBLL proportion decreased over time, from a high of 0.11 in 2006 to a low of 0.02 in 2015. The association between neighborhood deprivation and EBLL risk was positive and significant annually, but generally diminished over time. The most important variables in the neighborhood deprivation index were percent of houses built before 1940 and median household income. In summary, using Bayesian index models that can account for both temporal and spatio-temporal contexts is a promising approach to inform public health efforts to remediate lead and focus testing efforts and may be useful in studies in other geographic areas and times.

Evaluating Housing Characteristics Associated With Childhood Lead Exposure in Providence, Rhode Island.

This research aims to take an in-depth look into the child, housing, and neighborhood characteristics associated with Providence children's likelihood of having elevated blood lead levels (BLLs). The 2019 Providence, Rhode Island, Property Tax Assessor's database, containing each property owner's address, was geocoded and spatially joined with the 2017-2019 blood lead tests for children aged 0 to 6 years from the Rhode Island Department of Health. The prevalence of elevated BLLs (≥5 μg/dL) overall, as well as by property type, number of properties owned, owner occupancy, assessed value, and neighborhood rates of old housing and poverty, was computed. We assessed the relationship between having elevated BLLs and these housing and neighborhood characteristics, adjusting for gender, age at test, and test method. We found that, compared with children living in properties with landlords who owned only one property, children living in properties with landlords who owned 4 or more properties had lower odds of having elevated BLLs (odds ratio = 0.98; 95% confidence interval, 0.97-0.99). The proportion of houses built pre-1950 in the neighborhood was associated with increased odds of elevated BLLs. There was no significant association between owner-occupancy status and property type with children having elevated BLLs. Children living in properties with landlords who owned 4 or more properties were less likely to have elevated BLLs. This association may suggest that the current lead legislation is having some impact, but public health efforts should address lead exposure in properties that are currently exempt from the law.

An Observational Study of the Association Between Exposure to Vacant Building Demolitions and Elevated Blood Lead Levels in Children Under Six in St Louis City.

St Louis City has been demolishing vacant buildings at an increasing rate. Demolition can cause lead dust spread, and childhood lead exposure can have negative effects on cognition, growth, and development. Previous studies show an association between exposure to multiple demolitions and elevated blood lead levels (EBLLs) in children, but St Louis City does not monitor the effects of demolitions on children's blood lead levels. The purpose of this study was to measure the association between exposure to demolitions and EBLLs in children younger than 6 years in St Louis City from 2017 to 2020. We analyzed blood lead testing data for children 0 to 72 months of age (n = 22 192) and proximity to demolitions. Exposure was the presence of demolitions within 400 ft of a child's address in the 33 days before their first lead test. We used logistic regression to test the association between proximity to demolition and EBLLs (≥5 µg/dL). The percentage of children living in proximity to 1 or more demolitions was slightly higher among those with EBLLs (n = 21; 1.3%) than among those without EBLLs (n = 250; 1.2%). However, after adjusting for age, sex, year home was built, season, neighborhood socioeconomic percentile, and neighborhood racial composition, the odds of EBLLs were not significantly different for children exposed to 1 or more demolitions (OR = 0.82; 95% CI, 0.5-1.25) compared with exposed to zero demolitions. Although this study found no association between exposure to demolitions and EBLLs, results should be interpreted with caution, given numerous limitations. Given the consequences of childhood lead exposure, it is recommended that St Louis City conduct a similar analysis on demolitions conducted after 2020 using systematically collected demolition dates. Targeted testing or soil and air monitoring could also be informative.