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Reductions in Blood Lead Level Screening During Peak COVID-19 Restrictions and Beyond
Meghan L McCarthy1, Jonah Bradenday2, Elizabeth Chen1,2
1Warren Alpert Medical School of Brown University Providence Rhode Island USA.
Insights
COVID-19 significantly disrupted children's blood lead level (BLL) screening, with a 48% drop in Q2 2020. Screening remained lower in 2020 and 2021, with a higher proportion of abnormal BLLs observed.
Area of Science:
- Pediatric Public Health
- Environmental Health
- Epidemiology
Background:
- The COVID-19 pandemic caused major disruptions to routine pediatric primary care.
- Blood lead level (BLL) screening for children was significantly interrupted.
- This study examines BLL screening trends before and during the pandemic.
Purpose of the Study:
- To investigate trends in pediatric blood lead level (BLL) screening.
- To analyze screening data before and during the COVID-19 pandemic.
- To assess the impact of the pandemic on BLL screening in Rhode Island.
Main Methods:
- Utilized patient-level electronic health record data from CurrentCare, Rhode Island's HIE.
- Analyzed de-identified data from January 2018 to December 2021.
- Employed the ATLAS analytics platform (OHDSI) for data extraction and standardization.
Main Results:
- A 48% decrease in BLL screening occurred in Q2 2020 compared to Q2 2019.
- Overall BLL screening in 2020 was 16% lower than in 2019, and 23% lower in 2021.
- The proportion of abnormal BLLs (3.5-5.0 µg/dL) increased despite reduced screening numbers.
Conclusions:
- Significant deficiencies in pediatric BLL screening persist post-pandemic onset.
- The COVID-19 pandemic has markedly impacted lead screening and exposure in children.
- Statewide health information exchange data highlight ongoing challenges in lead screening.
Background And Objectives:
Among the multitude of health effects on children associated with the COVID-19 pandemic, there have been significant interruptions in the provision of routine pediatric primary care, including blood lead level (BLL) screening. We aimed to investigate trends in BLL screening before and during the pandemic era using patient-level electronic health record data extracted from CurrentCare, Rhode Island's statewide health information exchange (HIE).
Methods:
De-identified data were analyzed from CurrentCare for the study period January 2018 to December 2021. We utilized ATLAS, a web-based analytics platform from the Observational Health Data Sciences and Informatics (OHDSI) community, to extract and stratify BLL by variables of interest from the CurrentCare data, standardized to OHDSI's Observational Medical Outcomes Partnership common data model.
Results:
A decrease in BLL screening occurred in the spring of 2020, aligning with initial periods of shelter-in-place in response to the novel coronavirus outbreak; there was a 48% decrease comparing quarter 2 (April to June) of 2019 and 2020. BLL screening rebounded in the summer of 2020, however, it remained 16% lower overall in 2020 than in 2019. In 2021, BLL screening fell again to 23% lower than in 2019. Although overall numbers of BLL screenings were reduced, the proportion of abnormal BLLs was higher, particularly in the range of 3.5-5.0 µg/dL.
Conclusions:
Leveraging statewide HIE data, we found that significant deficiencies in BLL screening remain unresolved since the beginning of the COVID-19 pandemic. The disruption of children's lives by the COVID-19 pandemic appears to have greatly affected lead screening and exposure in Rhode Island.
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