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Published on: January 24, 2012
Blood lead testing among Medicaid-enrolled children in Michigan
Alex R Kemper1, Lisa M Cohn, Kathryn E Fant
1Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, USA. kempera@med.umich.edu
Insights
Blood lead testing rates for Medicaid children in Michigan were low, with testing often targeted to high-risk groups. This approach may miss elevated lead levels in some children requiring intervention.
Area of Science:
- Environmental Health
- Pediatric Health
- Public Health Policy
Background:
- Federal regulations require blood lead testing for Medicaid-enrolled children at ages 1-2 or 3-5 if not previously tested.
- Lead poisoning remains a significant public health concern, particularly for children in low-income households.
Purpose of the Study:
- To assess blood lead testing rates among Medicaid children in Michigan.
- To determine the prevalence of elevated blood lead levels and associated risk factors.
- To identify factors influencing testing rates and elevated levels.
Main Methods:
- Retrospective analysis of 216,578 children aged 5 years or younger enrolled in Michigan Medicaid in 2002.
- Examined blood lead testing rates, prevalence of elevated levels (≥10 µg/dL), and demographic/geographic risk factors.
- Investigated the association between Medicaid managed care enrollment and testing likelihood.
Main Results:
- The overall blood lead testing rate was 19.6%, with 8.3% of tested children having elevated levels.
- Hispanic/nonwhite children and those in high-risk areas were more likely to be tested and have elevated levels.
- Medicaid managed care enrollment increased the odds of testing, with 1.2% of tested children without identified risk factors showing elevated levels.
Conclusions:
- Blood lead testing rates among Medicaid-enrolled children in Michigan were found to be low.
- Testing appeared targeted towards high-risk populations, potentially resulting in underdiagnosis of lead exposure in other groups.
- Findings suggest a need to re-evaluate testing strategies to ensure comprehensive screening for all at-risk children.
Background:
Federal regulations mandate that Medicaid-enrolled children be tested for lead poisoning at the age of 1 and 2 years or 3 through 5 years if not previously tested.
Objectives:
To measure the rate of blood lead testing among Medicaid-enrolled children in Michigan and the subsequent proportion of children with elevated lead levels and to determine factors associated with testing and elevated lead levels.
Methods:
We performed a retrospective analysis of children aged 5 years or younger continuously enrolled in Michigan Medicaid during 2002.
Results:
There were 216,578 children included in the analysis. The overall rate of blood lead testing was 19.6% (95% confidence interval [CI], 19.4-19.8) of which 8.3% (95% CI, 8.0-8.5) had a level of 10 microg/dL [0.48 micromol/L] or higher. Hispanic or nonwhite children or those living in high-risk areas for lead exposure were more likely to be tested and more likely to have an elevated blood lead level. However, 1.2% of tested children without these additional risk factors had a level of 10 microg/dL or higher. Enrollment in Medicaid managed care was associated with an increased likelihood of blood lead testing. After adjusting for other factors, those in managed care for 75% or more of their enrollment in 2002 had 1.98 (95% CI, 1.46-2.68) greater odds of being tested than those in fee-for-service for 75% or more of their enrollment.
Conclusions:
The rate of blood lead testing was low. Patterns suggest testing was targeted to those at highest risk, potentially leading some children with elevated blood lead levels to be missed.
