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Evaluating the Effectiveness of State-Level Policies on Childhood Blood Lead Testing Rates
Perri Zeitz Ruckart1, Frank J Bove, Cham Dallas
1Lead Poisoning Prevention and Surveillance Branch (proposed), Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Ruckart); Office of Community Health and Hazard Assessment, Agency for Toxic Substances and Disease Registry, Atlanta, Georgia (Dr Bove); Department of Health Policy & Management, College of Public Health, University of Georgia, Athens, Georgia (Dr Dallas); Department of Emergency Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia (Dr Dallas); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Dallas).
Context:
Lead exposure can harm nearly every organ in the human body. Millions of US children are exposed to lead hazards. Identifying lead-exposed children using blood lead testing is essential for connecting them to appropriate follow-up services. However, blood lead testing is not consistently conducted for at-risk children. Thus, determining which policies help improve blood lead testing rates is essential.
Objective:
This analysis provides critical evidence to better understand which state-level policies are more effective at increasing childhood blood lead testing rates. These include metrics, incentives, other managed care organization guidance, provider guidelines, mandatory reporting of results to state health departments, data sharing between Medicaid and other state agencies, and proof of testing for school enrollment.
Design:
This analysis included 33 states with complete data on the number of children tested for blood lead in 2017-2018 as reported to the Centers for Disease Control and Prevention. Linear regression modeling was conducted to examine associations between testing rates and the aforementioned policies. Fully adjusted models included percentages of the population living in pre-1980 housing, younger than 6 years with Medicaid coverage, and foreign-born.
Results:
Strongest unadjusted and adjusted regression coefficients were observed for requiring proof of testing for school enrollment (β = .12, P = .03) and metrics (β = .06, P = .01), respectively.
Conclusion:
Policies associated with higher childhood blood lead testing rates can be used by policy makers; local, state, and federal public health agencies; professional organizations; nonprofit organizations; and others to inform development and implementation of additional policies to increase childhood blood lead testing.
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