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PEDIATRICS Vol. 106 No. 6 December 2000, p. e79

ELECTRONIC ARTICLE:
Elevated Blood Lead Levels and Blood Lead Screening Among US Children Aged One to Five Years: 1988-1994

Received Oct 19, 1999; accepted Jul 24, 2000.

Rachel B. Kaufmann*, Timothy L. ClouseDagger , David R. Olson*, and Thomas D. Matte*, §

From the * Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Dagger  Health, Education, and Human Services Division, US General Accounting Office, Atlanta, Georgia (the views expressed in this article are those of the author and not necessarily those of the US General Accounting Office); and the § Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, New York.

Objectives.  To estimate the proportion of children 1 to 5 years of age who received blood lead testing during 1988-1994 and to assess whether predictors of testing coincided with predictors of elevated blood lead levels.

Design.  Cross-sectional analysis of data from the Third National Health and Nutrition Examination Survey.

Participants.  US children 1 to 5 years of age.

Outcome Measures.  Prevalence of blood lead testing and elevated blood lead levels among children 1 to 5 years of age and odds ratios for factors predicting blood lead testing and elevated blood lead levels.

Results.  Overall, 6.3% had elevated blood lead levels and 10.2% had undergone previous blood lead tests. Being of minority race/ethnicity, living in an older home, residing in the Northeast or Midwest regions of the United States, being on Medicaid, having a head of household with <12 years of education, and having a history of anemia were significant factors in both models. Additional independent risk factors for an elevated blood lead level included being sampled in phase 1 of the survey, being 1 to 2 years of age, not having a regular doctor, and being sampled during the summer months. Additional independent correlates of a previous blood lead test included having moved less than twice in one's lifetime, having a female head of household, and having parents whose home language was English. Of an estimated 564 000 children 1 to 5 years of age who had elevated blood lead levels and no previous screening test in 1993, 62% were receiving Medicaid, 40% lived in homes built before 1946, and 34% were black, non-Hispanic.

Conclusions.  Lead screening was more frequent among children with risk factors for lead exposure. However, among children with elevated blood lead levels, only one third had been tested previously. In 1993 an estimated 564 000 children 1 to 5 years of age had elevated blood lead levels but were never screened. Physicians should screen Medicaid-eligible children and should follow state or local health department recommendations about identifying and screening other at-risk children. In areas where no health department guidelines exist, physicians should screen all children or screen based on known risk factors.  Key words:  lead poisoning, blood lead, children, screening, epidemiology, risk factors.




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A. R. Kemper, L. M. Cohn, K. E. Fant, K. J. Dombkowski, and S. R. Hudson
Follow-up Testing Among Children With Elevated Screening Blood Lead Levels
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[Abstract] [Full Text] [PDF]

P3Rs:

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Pb exposure in child (day) care should be considered
Susan S Aronson
Pediatrics Online, 5 Dec 2000 [Full text]
Pb exposure in child (day) care should be considered: the authors reply
Rachel Kaufmann
Pediatrics Online, 15 Dec 2000 [Full text]