Increased Risk of Sub-Clinical Blood Lead Levels in the 20-County Metro Atlanta, Georgia Area—A Laboratory Surveillance-Based Study

Abstract

Lead (Pb) is a naturally occurring, highly toxic metal that has adverse effects on children across a range of exposure levels. Limited screening programs leave many children at risk for chronic low-level lead exposure and there is little understanding of what factors may be used to identify children at risk. We characterize the distribution of blood lead levels (BLLs) in children aged 0–72 months and their associations with sociodemographic and area-level variables. Data from the Georgia Department of Public Health’s Healthy Homes for Lead Prevention Program surveillance database was used to describe the distribution of BLLs in children living in the metro Atlanta area from 2010 to 2018. Residential addresses were geocoded, and “Hotspot” analyses were performed to determine if BLLs were spatially clustered. Multilevel regression models were used to identify factors associated with clinical BBLs (≥5 µg/dL) and sub-clinical BLLs (2 to <5 µg/dL). From 2010 to 2018, geographically defined hotspots for both clinical and sub-clinical BLLs diffused from the city-central area of Atlanta into suburban areas. Multilevel regression analysis revealed non-Medicaid insurance, the proportion of renters in a given geographical area, and proportion of individuals with a GED/high school diploma as predictors that distinguish children with BLLs 2 to <5 µg/dL from those with lower (<2 µg/dL) or higher (≥5 µg/dL) BLLs. Over half of the study children had BLLs between 2 and 5 µg/dL, a range that does not currently trigger public health measures but that could result in adverse developmental outcomes if ignored.

Rural and Urban Ecologies of Early Childhood Toxic Lead Exposure -- the State of Kansas, 2005 to 2012

“…In contrast to other states, higher EBLL rates were found in less urbanized and more rural areas in Kansas. Rural areas typically experience lower EBLL rates than urban cities, 41 – 44 although similar EBLL rates were found between rural and urban newborns in Iowa. 45 This may be unique to Kansas in part from a greater rural population, major urban cities that are comparatively smaller than others, much older and substandard housing, rural healthcare disparities related to access and affordability, and higher rates of soil contamination and industrial emissions as found in previous studies.…”

“…[49][50][51][52][53] In contrast, suburban areas that typically are more affluent and predominately White were found to have much lower lead burdens compared to other areas outside of the suburbs. 43,44 By region, the highest EBLL rates were found in Southeast Kansas, which is part of the Midwestern "lead belt" primarily located in Southwest Missouri and also includes Northeast Oklahoma. This region of Kansas has long been impacted by historical and ongoing issues of lead pollution largely resulting from mining and smelting operations centered around the urban cluster city of Galena, Kansas.…”

“… 49 – 53 In contrast, suburban areas that typically are more affluent and predominately White were found to have much lower lead burdens compared to other areas outside of the suburbs. 43 , 44 …”

Predicting Low-Level Childhood Lead Exposure in Metro Atlanta Using Ensemble Machine Learning of High-Resolution Raster Cells

“…Previously, we identified individual-and community-level factors that distinguished children with BLLs <2, 2-5, and ≥5 µg/dL [21]. As we previously showed [21], metro Atlanta has a significant number of children exposed to both lower and higher levels of lead within the Healthy Homes for Lead Prevention Program database.…”

“…Previously, we identified individual-and community-level factors that distinguished children with BLLs <2, 2-5, and ≥5 µg/dL [21]. As we previously showed [21], metro Atlanta has a significant number of children exposed to both lower and higher levels of lead within the Healthy Homes for Lead Prevention Program database. We concluded that a greater number of U.S. children aged 2-6 years were at risk for low-level lead exposure than the previously estimated [22] 500,000 children.…”