Risk Of Lead Poisoning Research Articles

The Prevalence Of Lead Poisoning in a Pediatric Population in Rural Pennsylvania

Objective: To determine the prevalence of lead poisoning in a pediatric population in rural Pennsylvania. Design: A prospective clinical study. Setting: A Pediatrician's office in rural north central Pennsylvania. Patients: Three hundred fifty-three children aged nine months through six years presenting to their pediatrician's office for well-child or illness care over a 10 month period in 1992. Methods: Capillary blood samples were obtained on study patients and analyzed by atomic absorption for blood lead levels. Concurrently, questionnaires were administered to parents of study patients to assess their children's risk factors for lead poisoning. Main Results: Overall, 15% of children had blood lead levels greater than or equal to 0.48 micromole/L (10 micrograms/dL), 5% had levels greater than or equal to 0.72 micromole/ L (15 micrograms/dL), and 2% had levels greater than or equal to 1.0 micromole/L (20 micrograms/dL). The prevalence of lead poisoning was highest in children aged two to three years. Children on Medical Assistance had a higher prevalence of lead poisoning (23.5%) than children not on Medical Assistance (7.5%). The greatest source of lead exposure was lead-based paint found in homes built before 1977. Conclusions: These results demonstrate that there is a significant prevalence of lowlevel lead poisoning in this rural community and suggest that there may be a need for more extensive screening in geographic areas not usually thought to be at high risk for lead poisoning.

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

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.

Identifying Children at Risk for Lead Poisoning

Identifying Children at Risk for Lead Poisoning

Use of the centers for disease control and prevention childhood lead poisoning risk questionnaire to predict blood lead elevations in pregnant women

To assess the accuracy of a questionnaire developed by the Centers for Disease Control and Prevention (CDC), given to pregnant women for identification of children at risk for lead poisoning. The study population consisted of all 314 new prenatal patients enrolled in health department clinics in 1990-1992. Lead was measured in venous blood, and patients completed written questionnaires to gather information about lead exposure risk factors. The relationship between elevated maternal blood lead levels (at or greater than 10 micrograms/dL or 0.483 mumol/L) and responses to the CDC questionnaire and other questions were examined using chi 2 statistical analysis. Two hundred ninety-nine women provided responses to questions about lead exposure risk. Thirty-nine women (13%) had elevated blood lead levels. A woman with a positive response to at least one CDC question was more likely to have elevated blood lead than a woman who answered negatively to all four CDC questions (relative risk = 2.39, 95% confidence interval 1.17-4.89; P = .01). Using the CDC definition of high risk ("yes" to at least one question), the questionnaire had a sensitivity of 75.7% and a negative predictive value of 93.1%. A questionnaire that combined housing conditions, smoking status, and high consumption of canned foods had a sensitivity of 89.2% and a negative predictive value of 96.4%. A high prevalence of elevated blood lead in children living with women with elevated blood lead was observed. Querying pregnant women about risk factors for lead exposure can aid in assessing prenatal lead exposure risk. The sensitivity and negative predictive value of the CDC questionnaire, when used with high-risk women, are comparable to its reported accuracy in young children.

Identification of Children At Risk for Lead Poisoning: An Evaluation of Routine Pediatric Blood Lead Screening in an HMO-Insured Population

To estimate the prevalence of elevated blood lead levels in children receiving well-care checkups; and to evaluate the effectiveness of certain key risk factors in detecting children at higher risk for elevated blood lead levels. Cross-sectional study. Two facilities of the Kaiser Permanente Medical Care Program (KPMCP) health maintenance organization (HMO), northern California region. Six hundred thirty-six children, aged 12 to 60 months, who were seen at four KPMCP facilities in two subregions for a well-care checkup from September 1991 through August 1992. Blood samples were collected from each child and analyzed for lead content. Participating parents completed a questionnaire that included questions recommended by the Centers for Disease Control and Prevention (CDC) about the child's and the parents' lead exposure via home, workplace, and hobbies. Ninety-six percent of the children had blood lead levels under 10 micrograms/dL. Blood lead levels declined with increasing age and were higher for black children compared with whites. Age of residential housing, mother's education, and residence in an old house with peeling paint had low sensitivity and positive predictive value for identifying children with blood lead levels over 10 micrograms/dL. Universal routine screening for elevated blood lead levels in children in an employed, HMO-insured population is not warranted on grounds of prevalence. Responses to CDC questions do not effectively identify high-risk children in this population.

Lead Poisoning Risk Determination in a Rural Setting

To determine the prevalence of elevated blood lead levels among children living in a rural area and to determine the effectiveness of the Centers for Disease Control and Prevention (CDC) Lead Risk Assessment Questionnaire and additional questionnaire items in correctly identifying rural children having elevated blood lead levels. Comparison of results of a questionnaire that is intended to identify children as being at low or high risk for lead poisoning with children's blood lead levels. The three practice sites of the only pediatric group in a rural county of upstate New York. A consecutive sample of 705 children ages 6 to 72 months who were seen for health supervision visits between June and September 1993. Sixty-nine percent of the children were considered to be at high risk for lead poisoning by the CDC questionnaire. Overall, 8.4% of the children in the study had blood lead levels of 10 micrograms/dL (0.48 mumol/L) or higher, and 2.1% had blood lead levels of 15 micrograms/dL (0.72 mumol/L) or higher. No significant difference was noted between the percentages of high- and low-risk children who had elevated blood lead levels. To devise a more effective lead risk assessment tool for children in this setting, the two items from the CDC questionnaire and the two additional items that had the greatest predictive utility were combined to form a short alternative questionnaire. The alternative questionnaire thus consisted of items concerning whether the child has a sibling or playmate with lead poisoning, whether the child lives near an industry that potentially may release lead, whether the child lives in rented or owner-occupied housing, and whether the child has a parent who is a migrant farm worker. Children categorized as high risk with the alternative questionnaire were much more likely to have elevated blood lead levels than those who were categorized as low risk. The alternative questionnaire was very effective in correctly identifying children with elevated blood lead levels. Eighty-eight percent of children having blood lead levels of 10 micrograms/dL or higher and 100% of children having blood lead levels of 15 micrograms/dL or higher were classified as high risk by the questionnaire. Children classified as low risk were very unlikely to have elevated blood lead levels; 98% of low-risk children had blood lead levels of less than 10 micrograms/dL, and 100% had blood lead levels of less than 15 micrograms/dL. These results suggest that the CDC lead risk assessment questionnaire is of limited benefit in identifying rural children with blood lead levels 10 micrograms/dL or higher or 15 micrograms/dL or higher. An alternative questionnaire, however, seems to have marked clinical utility for identifying rural children with elevated blood lead levels.

Lead Exposure in Day Care Centers

The risk of lead poisoning among 155 of 234 eligible children (mean age, 4.8 years) enrolled in university affiliated day care centers with elevated environmental lead sources was determined at the Department of Pediatrics and University Hygienic Laboratory, The University of Iowa, Iowa City.

Elevated environmental lead levels in a day care setting.

To determine the risk of lead poisoning among children enrolled in day care centers with elevated environmental lead burdens. Survey. Six day care centers on properties owned by a major state-supported university. One hundred fifty-five of 234 eligible children (mean age, 4.8 years) enrolled in these centers were screened by questionnaire for risk factors of lead exposures. Blood samples for lead levels were also obtained. Observations of day care activities relative to lead exposure risks were recorded. Analyses of lead levels in paint, dust, and/or soil samples at the six centers were obtained. Prevalence of elevated blood lead levels and associated behavioral risk factors for lead exposure in children attending day care centers. Elevated levels of lead in paint (2.4% to 40% lead) were present in all day care facilities. Three day care centers had elevated lead levels in windowsill dust (62,000 to 180,000 micrograms [corrected] of lead per square meter) or soil (530 to 1100 mg of lead per kilogram): Questionnaires documented low risk for lead exposure to children in the home environments. Direct observations in the day care setting revealed optimal supervision and hygiene of the children. Blood lead levels were less than 0.5 mumol/L (10 micrograms/dL) in all but one of the 155 children screened. Children attending day care centers with high environmental lead burdens need further documentation of blood lead levels, at-risk behaviors, and lead exposure risks in the home environments as an adjunct to the instigation of lead abatement procedures at the day care centers.

Risk of lead poisoning in abused and neglected children.

This study examined the prevalence of lead poisoning in 746 abused and neglected children taken into protective custody by Cook County, Illinois, Child Protective Services, Department of Children and Family Services (DCFS). Most of these children had a history of neglect (62%) or dependency (23%); they were predominantly African-American (88%). Venous blood lead concentrations (PbB) were obtained on 589 children, ages 6 months to 6 years, between January 1, 1992, and December 31, 1992. Three hundred eighty-one (64.7%) children tested had a PbB > or = 10 micrograms/dL (0.48 mumol/L); the mean PbB was 12.23 micrograms/dL (0.587 mumol/L). These data support a recommendation for lead screening in any child with a history of abuse or neglect if environmental risk factors cannot be assessed.

Prevalence of Lead Poisoning in an Urban Cohort of Infants With High Socioeconomic Status

The purpose of this study was to assess the prevalence of lead poisoning in an urban cohort of infants with high socioeconomic status and to determine the usefulness of the Centers for Disease Control (CDC) questionnaire in predicting lead poisoning. The CDC questionnaire was administered to consecutive parents of infants, beginning with their 6-month well-child visit. All infants had a venous lead level by 12 months of age. The 165 infants were between 5.9 and 12 months (mean = 9.4 months). The majority (67%) lived in a major city, had parents who were college graduates (67%), and had private medical insurance (85%). The overall prevalence of lead poisoning (Pb > or = 10 micrograms/dL [0.483 mumol/L]) was 29%. The relative risk of lead poisoning, given exposure as defined by the CDC instrument, was 0.99 (95% CI = .81 to 1.21). The sensitivity and specificity of the questionnaire were 40% and 60%, respectively. We conclude that the prevalence of lead toxicity and the poor sensitivity of the CDC questionnaire in this cohort of urban infants with high socioeconomic status support the 1991 CDC recommendation for universal lead screening in this region.

Screening for Pediatric Lead Poisoning

<h3>Objective.</h3> —To determine the ability of capillary blood lead levels to accurately reflect true blood lead levels in children at risk for lead poisoning. <h3>Design.</h3> —A correlation study in which lead levels of capillary blood specimens obtained by four different methods were compared with lead levels of simultaneously drawn venous blood specimens. <h3>Setting.</h3> —A central-city pediatric primary care clinic and door-to-door home visits in one central-city neighborhood. <h3>Patients.</h3> —Two hundred ninety-five children at high risk for lead poisoning aged 6 months to 6 years. <h3>Main Outcome Measures.</h3> —Blood lead levels of simultaneously drawn capillary and venous blood specimens. <h3>Results.</h3> —Lead levels of all four capillary sampling methods were highly correlated (correlation coefficient ≥0.96) with matched venous blood lead levels, with mean capillary-venous differences less than 0.05 μmol/L (1 μg/dL). <h3>Conclusions.</h3> —Capillary sampling is an acceptable alternative to venipuncture for lead-poisoning screening in young children. (<i>JAMA</i>. 1994;271:1346-1348)

Moonshine, Lead Poisoning, and Pragmatism-Reply

We thank Kirkland for his letter in which he proposes a provocative approach to decreasing the risk of lead poisoning associated with the consumption of alcohol in Alabama. Kirkland emphasizes that the problem is not a new one. Kirkland advocates the substitution of copper coil for lead-containing automobile radiators used in the distillation of moonshine and draws an analogy to needle-exchange programs for injecting drug users. Needle-exchange programs have been advocated by some persons to prevent the person-to-person transmission of blood-borne pathogens, including human immunodeficiency virus. Like needle exchange, substitution of copper coil may decrease the risk of adverse health events (ie, lead poisoning) associated with the use of an illicit substance. However, apart from public health implications, substantial political, legal, and logistic barriers stand in the way of implementing such a program. Lead-free alcohol can be purchased legally—the distillation, distribution, sale, and consumption of moonshine are illegal activities

Do Questions About Lead Exposure Predict Elevated Lead Levels?

To assess the usefulness of the lead poisoning questionnaire developed by the Centers for Disease Control and Prevention as a screening tool for elevated lead levels. This descriptive study used a five-question questionnaire at our hospital-based general pediatric clinic and in two local private practices. We obtained venous lead levels from 485 children aged 9 months to 6 years who were brought for health supervision visits. The questionnaire was completed by a primary caretaker of 330 patients (68%). Contingency tables were used to compare lead levels with the responses on the questionnaire. Lead levels of > or = 10 micrograms/dL were found in 23 (7%) of 330 who completed the questionnaire. Caretakers of children with elevated lead levels were more likely to answer yes to questions about chipping paint and home remodeling than those whose children had levels < 10 (P = .0001). These questions had sensitivities for detecting elevated lead levels of 70% and 74% with negative predictive values of 97% and 98%, respectively. Questions about known contacts with lead poisoning and job or industrial exposure to lead each had sensitivities of < 10%. The Centers for Disease Control and Prevention's definition of high risk for lead poisoning (one or more positive responses) was nearly 90% sensitive for detecting elevated lead levels with a negative predictive value of 99%. This risk assessment questionnaire is an effective screening method for elevated lead levels in our population. Questions about the home environment were more sensitive indicators of elevated lead levels than other standard high-risk questions.

Prevalence of Excess Lead Absorption and Associated Risk Factors in Children Enrolled in a Midwestern Health Maintenance Organization

To assess the prevalence of lead intoxication in children in a defined low-risk population at the new levels recommended by the Centers for Disease Control and Prevention. During an 11-month period, whole blood lead tests were performed on 4678 children at routine well-child visits at 9 months and 2 years of age. For the last 8 months of the study, parents were asked to complete a prescreening risk factor questionnaire at these visits. The questionnaire and blood lead results were then matched. Data were collected from October 1, 1991 through August 31, 1992. The study subjects were all enrolled in Group Health, Inc, a large health maintenance organization. Its 17 staff model clinics serve urban and suburban populations in the Minneapolis-St. Paul area. More than 95% of the population had coverage based on employment, not Medicaid. Results indicated that 2.5% (n = 119) of the children had BPb levels > or = 10 micrograms/dL. Urban clinics had rates of elevated BPb levels three to eight times those of suburban clinics (P < .00001), but the number of elevated BPb levels at the suburban clinics was greater than expected. BPb levels were significantly higher in summer and fall (P < .00001). The prescreening questionnaire addressed five areas potentially associated with risk according to the literature: housing, siblings with lead poisoning, parental hobbies or work involving lead, proximity to highways, and use of cultural medicines. Positive correlations were found between elevated BPb levels and residences built before 1950 (P < .00001). For children living in housing built before 1950, positive correlations were found between elevated blood lead levels and peeling paint (P < .01) or remodeling (P < .0001). Children who are at low socioeconomic risk but who live in housing built before 1950 are at increased risk for lead poisoning. The risk is greater if the house has peeling paint and especially if there is recent or ongoing renovation. Recommendations based on these results and the Centers for Disease Control and Prevention guidelines are made for screening programs in similar populations, and for the need to increase community awareness concerning this issue.

Lead Poisoning Risk Assessment: Blood Lead Screening

The Centers for Disease Control and Prevention (CDC) lowered the blood lead level (BPb) considered a toxic risk to children from 25 mcg/dL to 10 mcg/dL in Oct 1991.

Blood Lead Levels in Children With Foreign Bodies

To determine the risk of increased blood lead levels in children with aural, nasal, or gastrointestinal foreign bodies, the authors prospectively obtained venous blood lead and erythrocyte protoporphyrin levels from 40 study patients and two control groups without foreign bodies (65 patients presenting to a medical clinic and 40 patients presenting to an emergency department). A questionnaire was used to assess environmental and behavioral risk factors for lead poisoning in the three groups. Mean blood lead level was higher in children with foreign bodies (P less than .001), and they were more likely to have a venous blood lead value of more than 1.2 mumol/L (25 micrograms/dL, P less than .01) than patients in either control group. Seventy-eight percent of study patients had no prior lead screening by parent's report vs 64% of emergency department control subjects and 55% of medical clinic control subjects. Control patients in the emergency department had the same incidence of elevated blood lead values as patients enrolled from the medical clinic (6%). No differences in environmental risk factors were found among the three groups. Study patients more often had a history of pica or ingestion of a poison than control patients from the medical clinic. Inner-city children with foreign bodies have increased lead exposure and may have an increased risk for lead poisoning. In areas of high prevalence of lead poisoning, children with foreign bodies should be screened for lead poisoning in the emergency department. General lead screening in the emergency department may be justified for high-risk, inner-city populations.

Six Children With Lead Poisoning

Although most commonly seen in children from lower socioeconomic backgrounds, all children are at risk for lead poisoning. Management is a potential problem for all primary care providers. Because few individuals in the primary care practice of pediatrics have many patients with lead poisoning, it may be difficult to understand the nuances of management. We describe six patients, each of whom reflects different aspects of lead poisoning in children, and discuss the lessons we have learned in the course of their treatment. We have found that graphic representation of the blood lead and erythrocyte protoporphyrin values is helpful in the longitudinal follow-up of these youngsters.

Lead poisoning among household members exposed to lead-acid battery repair shops in Kingston, Jamaica.

To investigate the risk of lead poisoning among household members exposed to 'backyard' battery repair shops (BBRS) in Kingston, Jamaica, environmental and blood lead (PbB) were measured at 24 households (112 individuals) with a BBRS worker or located at a BBRS premises and at 18 neighbourhood control households (74 individuals). Elevated PbB (greater than or equal to 25 micrograms per decilitre [micrograms/dl]) was common among subjects of all ages living at BBRS premises, especially among children less than age 12, 43% of whom had PbB greater than 70 micrograms/dl. Potentially hazardous soil and house dust lead levels were also common at BBRS premises, where 84% of yards had soil lead levels above 500 parts per million (geometric mean 3388 parts per million [ppm] at BBRS premises households with a BBRS worker). Geometric mean blood and environmental lead levels were significantly lower at control households, where less than 10% of subjects in all age groups had elevated PbB (maximum 33 micrograms/dl). Sharing a premises with a BBRS was a stronger determinant of household blood lead and environmental contamination than was the presence of a BBRS worker in a household. Blood lead levels were associated with soil and house dust lead levels in all age groups. We conclude that small battery repair shops, which have also been described in other developing countries, create a high lead poisoning risk for nearby residents.

New ceramics-related industry implicated in elevated blood lead levels in children.

Elevated lead levels have been implicated as a cause of a variety of health problems in children. Blood lead, erythrocyte protoporphyrin, and hemoglobin levels were measured for family members of workers exposed to lead borosilicate dust in a capacitor and resistor plant in Colorado. Previous studies in other lead-related industries have shown an increased risk of lead poisoning among workers' children through exposure to dust brought home on work clothes. Eighty-nine family members of 41 exposed workers were tested along with 62 family members of 30 unexposed comparison households. The mean blood lead level in the family members of exposed workers was significantly elevated compared with that of the unexposed group (10.2 vs. 6.2 micrograms/dl, p = .0001).

Evaluation of the current risk of lead poisoning in the ceramics industry

Evaluation of the current risk of lead poisoning in the ceramics industry