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Epidemiologic Characteristics of Children with Blood Lead Levels ≥45 μg/dL
Brett Keller1, Andrew Faciano1, Adey Tsega1
1New York City Department of Health and Mental Hygiene, New York, NY.
Insights
Severe childhood lead poisoning in NYC is linked to specific risk factors like eating paint or soil, and international travel. Early identification and intervention are crucial for affected children.
Area of Science:
- Pediatric Environmental Health
- Toxicology
- Public Health Policy
Background:
- Childhood lead poisoning remains a significant public health concern, despite declining incidence.
- Severe blood lead levels (BLLs) in children necessitate identification of risk factors and outcomes.
- Understanding these factors informs clinical practice and public health interventions.
Purpose of the Study:
- To identify risk factors for children with newly diagnosed blood lead levels (BLLs) ≥45 µg/dL in New York City (NYC).
- To describe the outcomes for these children during 2004-2010.
- To promote timely identification and inform clinical and public health policies.
Main Methods:
- Retrospective case series of 145 children in NYC with BLLs ≥45 µg/dL.
- Inclusion criteria: NYC residence and confirmatory venous BLL within 2 weeks of initial elevated BLL.
- Data linkage included case coordination, blood testing, and home inspection reports; comparison with NYC general child population.
Main Results:
- Major risk factors identified: eating paint (36%), international travel (34%), developmental delay (27%), imported products (26%), foreign-born status (14%), Pakistani descent (12%), eating soil (5%), and sickle cell disease (4%).
- Children with severe BLLs were more likely to be Asian or black and reside in pre-1940 housing compared to the general NYC child population.
- Median time for BLL to decline below 10 µg/dL was 3.26 years.
Conclusions:
- Severe lead poisoning cases still occur, requiring physician vigilance.
- At-risk populations include children ingesting paint/soil, traveling internationally (especially Pakistan), using imported products, or with developmental delays/sickle cell disease.
- Timely identification and targeted interventions are critical for managing severe childhood lead exposure.
Objectives:
To identify risk factors and describe outcomes for children newly identified with blood lead levels (BLLs) ≥45 µg/dL in New York City (NYC) during 2004-2010 to promote timely identification as well as inform clinical practice and public health policy.
Study Design:
Inclusion criteria were residence in NYC and an elevated confirmatory venous test within 2 weeks of the initial BLL ≥45 µg/dL. Data collected during case coordination of these children were linked with blood testing data and home inspection reports. Children with BLLs ≥45 µg/dL also were compared with the general population of children younger than 18 years of age in NYC.
Results:
A total of 145 children <18 years of age were newly identified with BLLs ≥45 µg/dL. The mean age was 3.83 years, and the median time for BLL to decline below 10 µg/dL was 3.26 years. Major reported risk factors were eating paint (36%), spending time outside the US (34%), having a developmental delay (27%), using imported products (26%), being foreign born (14%), being of Pakistani descent (12%), eating soil (5%), and having sickle cell disease (4%). Compared with the age-standardized NYC population, cases were more likely to be Asian or black and live in housing built before 1940.
Conclusions:
Although the incidence of lead poisoning has declined in the US, severe cases still occur. Physicians should be especially vigilant in certain at-risk populations including children who eat paint chips or soil, spend time outside the US (particularly in Pakistan), use imported products, or have developmental delays or sickle cell disease.
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