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Rural-urban blood lead differences in North Carolina children
E H Norman1, W C Bordley, I Hertz-Picciotto
1Preventive Services Branch, Division of Maternal and Child Health, North Carolina Department of Environment, Health, and Natural Resources, Raleigh 27611.
Insights
Blood lead elevation is surprisingly common in rural children, with risk factors including race and age. Rural residence emerged as a significant risk factor, highlighting the need for increased awareness of lead exposure in these populations.
Area of Science:
- Environmental Health
- Pediatric Health
- Public Health
Background:
- Lead exposure in young children poses significant health risks.
- Understanding the prevalence and risk factors for elevated blood lead levels is crucial for targeted interventions.
Purpose of the Study:
- To determine the prevalence of elevated blood lead levels in young children in a predominantly rural state.
- To identify key risk factors associated with blood lead elevation in this population.
Main Methods:
- A large cohort of 20,720 North Carolina children aged 6 months to 6 years were screened for blood lead levels between November 1992 and April 1993.
- Screening utilized capillary or venous blood lead measurements, primarily through public health departments targeting low-income families.
Main Results:
- Prevalence rates for elevated blood lead were 20.2% (≥10 µg/dL), 3.2% (≥15 µg/dL), and 1.1% (≥20 µg/dL).
- Risk factors included Black race (OR=2.1), age 2 years (OR=1.4), male gender (OR=1.2), and living in a rural county (OR=1.9).
- Rural residence significantly amplified risk among already high-risk subgroups.
Conclusions:
- The prevalence of elevated blood lead levels among children in rural communities is unexpectedly high.
- These findings underscore the necessity for increased physician awareness and screening for lead exposure in children residing outside urban centers.
Objective:
To examine the prevalence of and risk factors for having a blood lead elevation among young children in a predominantly rural state.
Methods:
20,720 North Carolina children at least 6 months and < 6 years of age were screened between November 1, 1992 and April 30, 1993 using either capillary or venous measurements of blood lead. Children were tested through routine screening programs that target low-income families and, hence, were not randomly selected. Eighty-one percent of the children were screened through local public health departments, and 19% were tested at private clinics.
Results:
The estimated prevalences of having an elevated blood lead level among those tested were: 20.2% (> or = 10 micrograms/dL), 3.2% (> or = 15 micrograms/dL), and 1.1% (> or = 20 micrograms/dL). Black children were at substantially increased risk of having a blood lead > or = 15 micrograms/dL (odds ratio (OR) = 2.1, 95% confidence interval (CI) = 1.7 to 2.5). Children aged 2 years old had an elevated risk (OR = 1.4, 95% CI = 1.1 to 1.7) compared to 1-year-olds, and males were at slightly increased risk (OR = 1.2, 95% CI = 1.0 to 1.4). Living in a rural county was nearly as strong a risk factor as race (OR = 1.9, 95% CI = 1.6 to 2.4). The effect of rural residence was even greater among certain subgroups of children already at highest risk of having an elevated blood lead. The type of clinic (public vs private) where a child was screened was not associated with blood lead outcome. These same trends were seen for children with blood lead levels > or = 20 micrograms/dL.
Conclusions:
Among children screened from rural communities, the prevalence of elevated blood lead is surprisingly high. Though few physicians have embraced universal lead screening, these data support the need for greater awareness of lead exposure in children living outside of inner-cities.