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Blood Lead Levels in Young Children: US, 2009-2015

      Objectives

      To evaluate trends in blood lead levels in children <6 years of age, this Quest Diagnostics Health Trends report builds on previously reported National Health and Nutrition Examination Survey data with a much larger national group and adds more detail and novel assessments.

      Study design

      This report describes the results from a 6-year retrospective study (May 2009-April 2015) based on >5 million blood lead level results (including >3.8 million venous results) from children <6 years old living in all 50 states and the District of Columbia. We evaluated yearly changes and examined demographic categories including sex, pre-1950s housing construction, poverty income ratios (PIRs), Medicaid enrollment status, and geographic regions.

      Results

      Among children <6 years old, 3.0% exhibited blood lead levels ≥5.0 μg/dL (high). There were significant differences in high blood lead levels based on sex, pre-1950s housing construction quintiles, and PIR <1.25 and PIR >5 (all P < .01). Health and Human Services regions, states, and 3-digit ZIP code areas exhibited drastically different frequencies of high blood lead levels and blood lead levels ≥10.0 μg/dL (very high). Generally, levels declined over time for all groups.

      Conclusion

      Examination of more than 5 million venous blood lead level results in children younger than 6 years old allowed for a robust, detailed analysis of blood lead level group results by geography and other criteria that are prohibited with the narrower National Health and Nutrition Examination Survey database. Progress in reducing the burden of lead toxicity is a public health success story that is incomplete with some identified factors posing larger, ongoing challenges.

      Keywords

      Abbreviations:

      ACCLPP (Advisory Committee on Childhood Lead Poisoning Prevention), CDC (Centers for Disease Control and Prevention), HHS (US Department of Health and Human Services), NHANES (National Health and Nutrition Examination Survey), PIR (Poverty income ratio)
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      References

        • Agency for Toxic Substances and Disease Registry
        Toxicological profile for lead.
        US Department of Health and Human Services, CDC, Agency for Toxic Substances and Disease Registry, Atlanta, GA2007
        • Parsons P.J.
        • Reilly A.A.
        • Esernio-Jenssen D.
        Screening children exposed to lead: an assessment of the capillary blood lead fingerstick test.
        Clin Chem. 1997; 43: 302-311
        • Centers for Disease Control and Prevention
        Blood lead levels in children aged 1-5 years – United States, 1999-2010.
        MMWR Morb Mortal Wkly Rep. 2013; 62: 245-248
        • Pirkle J.L.
        • Brody D.J.
        • Gunter E.W.
        • Kramer R.A.
        • Paschal D.C.
        • Flegal K.M.
        • et al.
        The decline of blood lead levels in the United States: the National Health and Nutrition Examination Surveys (NHANES).
        JAMA. 1994; 272: 284-291
        • Centers for Disease Control and Prevention
        Preventing lead poisoning in young children.
        CDC, Atlanta1991
        • CDC Advisory Committee on Childhood Lead Poisoning Prevention
        Low level lead exposure harms children: A renewed call for primary prevention.
        CDC, Atlanta2012
        • Chandramouli K.
        • Steer C.D.
        • Ellis M.
        • Emond A.M.
        Effects of early childhood lead exposure on academic performance and behavior of school age children.
        Arch Dis Child. 2009; 94: 844-848
        • Nigg J.T.
        • Nikolas M.
        • Mark Knottnerus G.
        • Cavanagh K.
        • Friderici K.
        Confirmation and extension of association of blood lead level with attention-deficit/hyperactivity disorder (ADHD) and ADHD symptom domains at population-typical exposure levels.
        J Child Psychol Psychiatry. 2010; 51: 58-65
        • Needleman H.L.
        • Schell A.
        • Bellinger D.
        • Leviton A.
        • Allred E.N.
        The long-term effects of exposure to low doses of lead in childhood. An 11-year follow-up report.
        N Engl J Med. 1990; 332: 83-88
        • Bellinger D.C.
        • Stiles K.M.
        • Needleman H.L.
        Low-level lead exposure, intelligence and academic achievement: a long-term follow-up study.
        Pediatrics. 1992; 90: 855-861
        • Rogan W.J.
        • Dietrich K.N.
        • Ware J.H.
        • Dockery D.W.
        • Salganik M.
        • Radcliffe J.
        • et al.
        The effect of chelation therapy with succimer on neuropsychological development in children exposed to lead.
        N Engl J Med. 2001; 344: 1421-1426
        • Centers for Disease Control and Prevention
        Response to Advisory Committee on Childhood Lead Poisoning Prevention Recommendations in “Low Level Exposure Harms Children: A Renewal Call of Primary Prevention” CDC.
        2012 (Accessed May 10, 2016)
        • Centers for Disease Control and Prevention
        Screening young children for lead poisoning: Guidance for state and local public health officials; Appendix C1: The Lead Laboratory.
        2013 (Accessed December 12, 2015)
      1. CDC Standard Surveillance Definitions and Classifications. 2013 (Accessed December 12, 2015)
      2. US Census Bureau, 2009-2013 5-Year American Community Survey, http://factfinder.census.gov/faces/tableservices/jsf/pages-/productview.xhtml?pid=ACS_13_5YR_B25034&prodType=table. Accessed December 12, 2015.

        • CDC
        Facts on Lead.
        2013 (Accessed December 12, 2015)
      3. US Census Bureau, 2008-2012 5-Year American Community Survey, http://factfinder.census.gov/faces/tableservices/jsf/pages/-productview.xhtml?pid=ACS_12_5YR_B17024&prodType=table. Accessed December 12, 2015.

      4. SAS, version 9.4. Cary, NC: SAS Institute.

        • Raymond J.
        • Wheeler W.
        • Brown M.J.
        Lead screening and prevalence of blood lead levels in children aged 1–2 years—Child Blood Lead Surveillance System, United States, 2002–2010 and National Health and Nutrition Examination Survey, United States, 1999–2010.
        MMWR Suppl. 2014; 63: 36-42
        • Centers for Disease Control and Prevention
        CDC's National Surveillance Data (1997-2014).
        2016 (Accessed March 10, 2016)
        • Lanphear B.P.
        • Weitzman M.
        • Winter N.L.
        • Eberly S.
        • Yakir B.
        • Tanner M.
        • et al.
        Lead-contaminated house dust and urban children’s blood lead levels.
        Am J Public Health. 1996; 86: 1416-1421

      Linked Article

      • Blood lead levels in young children: US, 2009-2015
        The Journal of PediatricsVol. 181
        • Preview
          We read with interest the article by McClure et al1 describing blood lead levels in young children from 2009 to 2015. Syracuse, New York, had the greatest reported prevalence of blood lead levels (BLLs) ≥5.0 µg/dL (40.1%) and ≥10 µg/dL (16.0%) compared with only 3.0% ≥ 5.0 µg/dL nationally. As the pediatricians directing the Central-Eastern NY Lead Poisoning Resource Center and the largest pediatrics office providing care to children receiving Medicaid in Onondaga County, we were motivated to analyze our own data.
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      • Selection bias in estimates of elevated blood lead levels in children
        The Journal of PediatricsVol. 181
        • Preview
          McClure et al1 examined blood lead level (BLL) test results in US children and reported the prevalence of elevated BLLs by state.1 The authors found that of 2345 Minnesota children, 10.3% had elevated BLLs, the highest proportion of any state. However, by restricting the analysis to children with venous samples analyzed by 1 diagnostic laboratory, their method produced biased estimates of elevated BLLs.
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      • Blood lead levels in Syracuse, New York, 2009-2015
        The Journal of PediatricsVol. 181
        • Preview
          The article by McClure et al1 cited the 3-digit ZIP code region 132, which includes Syracuse, New York, as the region with the largest proportion of high (40.1%) and very high (16.0%) blood lead levels among children <6 years of age. The rates cited in this study contrast sharply with those collected and reported by the Onondaga County Health Department for the city of Syracuse (12.3% and 2.9%, respectively, from 2009 to 2015).2 We seek to clarify for readers that the analysis was based only on blood samples that were analyzed for lead by Quest Diagnostics, which represents just 26% of the total children tested for lead in the 3-digit ZIP code region 132 (2009-2015).
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