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Risk for Elevated Blood Lead Levels in 3- and 4-Year-Old Children

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Abstract

Objective We conducted a study to evaluate the relation between environmental, demographic, and medical risk factors and late-onset childhood lead poisoning, defined as children who were poisoned at age 3 or older. Methods We performed a retrospective case–control study of 262 children whose test results showed non-elevated (<10 μg/dl) blood lead levels (BLLs) before age 2 but levels ≥10 μg/dl after age 3 and of 300 control children who had non-elevated BLL test results before age 2 and also after age 3. The target population was children receiving care at MetroHealth Medical Center in Cleveland, OH. We modeled the association between demographic and clinical risk factors and BLLs ≥10 μg/dl after age 3. Covariates considered were race, gender, body mass index, immunization status, mean corpuscular volume, hematocrit, red cell volume distribution width (RDW), red blood count, hemoglobin, baseline BLL result, and time between the baseline and second BLL test. Results Case children were more likely to be male (P < 0.0001), black (P = 0.0189) and to have a high RDW defined as ≥14.5 % (P = 0.0083). On the basis of the final model, children with BLLs 7–9 μg/dl before age 2 and again after a follow-up BLL test (<21 months) were more likely to become lead poisoned than were control children. The risk of black children developing lead poisoning increased over time, regardless of the child’s first BLL test result. Conclusions Although national recommendations are to test children’s blood lead levels at ages 1 and 2, children living in high-risk areas with such risk factors should have a blood lead test at these older ages.

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References

  1. Bellinger, D. C., & Needleman, H. L. (2003). Intellectual impairment and blood lead levels. New England Journal of Medicine, 349(5), 500–502.

    Article  PubMed  Google Scholar 

  2. Bellinger, D. C., Stiles, K. M., & Needleman, H. L. (1992). Low-level lead exposure, intelligence and academic achievement: A long- term follow-up study. Pediatrics, 90(6), 855–861.

    PubMed  CAS  Google Scholar 

  3. Dietrich, K., Ris, M., Succop, P., Og, B., & Bornschein, R. (2001). Early exposure to lead and juvenile delinquency. Neurotoxicology Teratology, 23(6), 511–518.

    Article  PubMed  CAS  Google Scholar 

  4. Needleman, H., McFarland, C., Ness, R., Fineberg, S., & Tobin, M. (2002). Bone lead levels in adjudicated delinquents. A case control study. Neurotoxicology Teratology, 24(6), 711–717.

    Article  PubMed  CAS  Google Scholar 

  5. Sciarillo, W., Alexander, G., & Farrell, K. (1992). Lead exposure and child behavior. American Journal of Public Health, 82(10), 1356–1360.

    Article  PubMed  CAS  Google Scholar 

  6. American Academy of Pediatrics, Committee on Environmental Health. (2005). Lead exposure in children: Prevention, detection, and management. Pediatrics, 116(4), 1036–1046.

    Article  Google Scholar 

  7. Centers for Disease Control and Prevention. (1997). Screening young children for lead poisoning. Guidance for state and local public health officials. Atlanta: US Department of Health and Human Services, Public Health Service.

    Google Scholar 

  8. Centers for Disease Control and Prevention. (2000). Recommendations for blood lead screening of young children enrolled in Medicaid: Targeting a group at risk. Atlanta: US Department of Health and Human Services.

  9. Advisory Committee on Childhood Lead Poisoning Prevention, Centers for Disease Control and Prevention. (2000). Recommendations for blood lead screening of young children enrolled in Medicaid: Targeting a group at high risk. MMWR, 49(RR-14), 1–13.

    Google Scholar 

  10. Piomelli S. (1998). Lead poisoning. In: Nathan D., & Orkin S. (Eds.), Hematology of infancy and childhood (5th ed., p. 482). Philadelphia: WB Saunders.

    Google Scholar 

  11. CAN, D. O. Database [database on the Internet]. Cleveland (OH): Center on Urban Poverty and Social Change, Mandel School of Applied Social Sciences, Case Western Reserve University. [cited 2004 Dec 19]. Available from: http://povertycenter.cwru.edu/urban_poverty/dev/cando/overview.asp.

  12. Lead poisoning. http://www.ehw.org Cleveland, (Ohio): Environmental Health Watch. cited 2005 Sep 2. Available from: http://www.ehw.org/Lead/LEAD_home3.htm.

  13. Centers for Disease Control and Prevention (CDC), National Center for Environmental Health. [homepage on the Internet]. Atlanta: CDC. [cited 2006 Dec 1]. Available from: http://www.cdc.gov/nceh/lead/surv.

  14. Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease and Health Promotion. [homepage on the Internet]. Atlanta: CDC. [cited 2005 Dec 1]. Available from: http://www.cdc.gov/nccdphp/dnpa/bmi-adult-formula.htm.

  15. Centers for Disease Control and Prevention, National Center for Chronic Disease and Health Promotion. [homepage on the Internet]. Atlanta: CDC. [cited 2005 Dec 1]. Available from: http://www.cdc.gov/nccdphp/dnpa/bmi/bmi-for-age.htm.

  16. Centers for Disease Control and Prevention, National Immunization Program. [homepage on the Internet]. Atlanta: CDC. [cited 2005 Nov 14]. Available from: http://www.cdc.gov/nip/casa/Default.htm.

  17. Centers for Disease Control and Prevention, National Immunization Program. [homepage on the Internet]. Atlanta: CDC. [cited 2005 Nov 14]. Available from: http://www.cdc.gov/nip/recs/child-schedule.htm.

  18. Breslow, N. E., & Day, N. E. (1980). The analysis of case–control studies. Statistical methods in cancer research. Vol.1. International Agency for Research on Cancer, IARC Scientific Publications No. 32.

  19. SAS/STAT. (2007). User’s guide. Version 8. Cary: SAS Institute Inc.

    Google Scholar 

  20. Brody, D. J., Pirkle, J. L., Gunter, E. W., et al. (1994). The decline in blood lead levels in the United States: the National Health and Nutrition Examination Surveys (NHANES). JAMA, 272, 284–291.

    Article  PubMed  Google Scholar 

  21. Kordas, K., Canfield, R. L., Lopez, P., Rosado, J. L., Vargas, G. G., Cebrian, M. E., et al. (2006). Deficits in cognitive function and achievement in Mexican first-graders with low blood lead concentrations. Environmental Research, 100, 371–386.

    Article  PubMed  CAS  Google Scholar 

  22. Chen, A., Dietrich, K. N., Ware, J. H., Radcliffe, J., & Rogan, W. J. (2005). IQ and blood lead from 2 to 7 years of age: Are the effects in older children the residual of high blood lead concentrations in 2-year-olds? Environmental Health Perspectives, 113(5), 597–601.

    Article  PubMed  CAS  Google Scholar 

  23. Looker, A. V., Gunter, E. W., Johnson, C. L. (1995). Methods to assess iron status in various NHANES surveys. Nutrition Reviews, 53(9), 246–254 (Review).

    Article  PubMed  CAS  Google Scholar 

  24. McClure, S., Custer, E., Bessman, J. D. (1985). Improved detection of early iron deficiency in nonanemic subjects. JAMA, 253(7), 1021–1023.

    Article  PubMed  CAS  Google Scholar 

  25. Uchida, T. (1989). Change in red blood cell distribution width with iron deficiency. Clinical and Laboratory Haematology, 11(2), 117–121.

    Article  PubMed  CAS  Google Scholar 

  26. Pirkle, J. L., Kaufmann, R. B., Brody, D. J., Hickman, T., Gunter, E. W., & Paschal, D. C. (1998). Exposure of the U.S. population to lead, 1991–1994. Environmental Health Perspectives, 106, 745–750.

    Article  PubMed  CAS  Google Scholar 

  27. Kwong, W. T., Friello, P., & Semba, R. D. (2004). Interactions between iron deficiency and lead poisoning: Epidemiology and pathogenesis. The Science of the Total Environment, 330(1–3), 21–37.

    PubMed  CAS  Google Scholar 

  28. Hunter, J. M. (1977). The summer disease: An integrative model of the seasonality aspects of childhood lead poisoning. Social Science & Medicine, 11, 691–703.

    Article  CAS  Google Scholar 

  29. Stark, A. D., Quah, R. F., Meig, J. W., & De Lousise, E. R. (1980). Season as a factor in variability of blood-lead levels in children. Connecticut Medicine, 44(7), 410–413.

    PubMed  CAS  Google Scholar 

  30. Rabinowitz, M., Leviton, A., Needleman, H., Bellinger, D., & Waternaux, C. (1985). Environmental correlates of infant blood lead levels in Boston. Environmental Research, 38(1), 96–107.

    Article  PubMed  CAS  Google Scholar 

  31. Rothenberg, S. J., Williams, F. A., Delrahim, S., Khan, F., Kraft, M., Lu, M., et al. (1996). Blood lead levels in children in south central Los Angeles. Archives of Environmental Health, 51(5), 383–388.

    Article  PubMed  CAS  Google Scholar 

  32. Yiin, L. M., Rhoads, G. G., & Lioy, P. J. (2000). Seasonal influences on childhood lead exposure. Environmental Health Perspectives, 108(2), 177–82.

    Article  PubMed  CAS  Google Scholar 

  33. Centers for Disease Control and Prevention (CDC). Managing elevated blood lead levels among young children: Recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention. Atlanta: US Department of Health and Human Services, CDC; 2002. [cited 2003 Nov 03]. Available from: http://www.cdc.gov/nceh/lead/CaseManagement/caseManage_main.htm.

  34. Lanphear, B. P., Burgoon, D. A., Rust, S. W., Eberly, S., & Galke, W. (1998). Environmental exposures to lead and urban children’s blood lead levels. Environmental Research, 76, 120–130.

    Article  PubMed  CAS  Google Scholar 

  35. Agency for Toxic Substances and Disease Registry (ATSDR). (1988) The nature and extent of lead poisoning in children in the United States: A Report to Congress. Atlanta: US Department of Health and Human Services.

    Google Scholar 

  36. Calabrese, E., & Stanke, E. (1992). What proportion of household dust is derived from outdoor soil? Journal of Soil Contamination, 1, 253–263.

    CAS  Google Scholar 

  37. Jacobs, D. E., Clickner, R. P., Zhou, J. Y., Viet, S. M., Marker, D. A., Rogers, J. W., Zeldin, D. C., Broene, P., & Friedman, W. (2002). The prevalence of lead-based paint hazards in U.S. Housing. Environmental Health Perspectives, 110, 599–606. [cited 2003 Nov 03]. Available from http://www.hud.gov/offices/lead/techstudies/HUD_NSLAH_Vol1.pdf.

  38. Bernard, S. M., & McGeehin, M. A. (2003). Prevalence of blood lead levels ≥5 μg/dl among US children 1 to 5 years of age and socioeconomic and demographic factors associated with blood lead levels 5–10 μg/dl, Third National Health and Nutrition Examination Survey, 1988–1994. Pediatrics, 112, 1308–1313.

    Article  PubMed  Google Scholar 

  39. Schlenker, T. L., Fritz, C. J., Murphy, A., & Shepeard, S. (1994). Feasibility and effectiveness of screening for childhood lead poisoning in private medical practice. Archives of Pediatrics & Adolescent Medicine, 148(7), 761–764.

    CAS  Google Scholar 

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Authors and Affiliations

  1. Lead Poisoning Prevention Branch, Division of Emergency and Environmental Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy., MS: F-40, Atlanta, GA, 30341, USA

    Jaime S. Raymond, David Homa & Mary Jean Brown

  2. MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA

    Roberta Anderson & Mark Feingold

Authors
  1. Jaime S. Raymond
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  2. Roberta Anderson
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  3. Mark Feingold
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  4. David Homa
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Correspondence to Jaime S. Raymond.

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Jaime S. Raymond and Roberta Anderson contributed equally to this work.

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Raymond, J.S., Anderson, R., Feingold, M. et al. Risk for Elevated Blood Lead Levels in 3- and 4-Year-Old Children. Matern Child Health J 13, 40–47 (2009). https://doi.org/10.1007/s10995-007-0297-x

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