Elevated Blood Lead Levels in Children With Sickle Cell Disease

Although prior reports suggest sickle cell disease (SCD) as a risk factor for lead poisoning, this association remains understudied. This paper assesses the relationship between SCD and elevated blood lead levels (BLLs) in New York City children.

We conducted a retrospective matched cohort study of children born in NYC from 2004 to 2016 and tested for BLLs from 2004 to 2022. Children with SCD were matched 1:2 to children without SCD based on maternal race and country of birth. Firth penalized-likelihood logistic regression estimated associations between SCD and BLLs ≥3.5, ≥5, ≥10, and ≥15 µg/dL, adjusting for Medicaid status, housing age, and maternal race. Additional analyses evaluated effect modification by age and SCD genotype.

The cohort included 1463 children with SCD and 2982 without SCD. SCD was associated with lower odds of BLLs ≥3.5 µg/dL (odds ratio [OR] 0.81; 95% confidence interval [CI]: 0.66-0.99), no difference at ≥5 µg/dL (OR 0.86; 95% CI: 0.66-1.10), and higher odds at ≥10 µg/dL (OR 1.82; 95% CI: 1.06-3.13), with a similar estimate at ≥15 µg/dL (OR 2.23; 95% CI: 0.98-5.07). The SCD-by-age interaction was significant at ≥10 µg/dL (OR 4.47; 95% CI: 1.41-15.50), and children with HbSS had significantly higher odds of BLLs ≥10 µg/dL and BLLs ≥15 µg/dL than children without SCD (OR 2.25 and 2.98, respectively).

Children with SCD have increased odds of elevated BLLs at higher thresholds, especially those aged ≥3 years and those with HbSS. Targeted rescreening of these children warrants consideration.