Epidemiologic Trends in Pediatric Lead Poisoning at Freestanding Children's Hospitals, 2016-2023

Elevated blood lead levels are still prevalent among children in the United States, and there continue to be published reports of severe childhood lead poisoning across the United States. However, the epidemiology of hospital encounters for severe lead poisoning is still unknown.

We included encounters for children with a primary diagnosis of lead poisoning using Pediatric Hospital Information System data from 2016 to 2023. We used descriptive statistics to characterize patient sociodemographic factors, clinical characteristics, and hospital utilization, as well as Poisson regression accounting for hospital state-level variation, to estimate lead poisoning rates by patient race and ethnicity, insurance payor, urbanicity, and Childhood Opportunity Index (COI) level.

There were 845 inpatient hospitalizations and 1137 emergency department visits for lead poisoning across 47 hospitals, resulting in over $4.5 million mean cumulative annual billed charges. Compared with patients who identified as white, non-Hispanic, patients who identified as Asian, non-Hispanic (incidence rate ratio [IRR], 1.75); Black, non-Hispanic (IRR, 1.44); and multiracial, non-Hispanic (IRR, 2.26) had significantly higher rates of lead poisoning encounters. Those with public insurance had higher rates of encounters compared with those with commercial insurance (IRR, 2.14). Patients in rural zip codes had significantly higher rates of encounters than patients in urban zip codes (IRR, 1.51). Patients in low- (IRR, 1.79) and very low-COI (IRR, 3.22) zip codes had significantly higher rates of encounters compared with those in very high-COI zip codes.

This study finds that severe lead poisoning remains a substantial health concern. We found significant disparities in the rate of encounters by sociodemographic factors that warrant further action.