Measurement Challenges at Low Blood Lead Levels

Caldwell, Kathleen L.; Cheng, Po‐Yung; Jarrett, Jeffery M.; Makhmudov, Amir; Vance, Kathryn A.; Ward, Cynthia D.; Jones, Robert L.; Mortensen, Mary Ellen

doi:10.1542/peds.2017-0272

Cited by 58 publications

(39 citation statements)

References 6 publications

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“…We believe that the low BLLs of children in Darkhan and Erdenet are, in all likelihood, also related to the downward trend from the phase-out of leaded gasoline in Mongolia. Our result is similar to the most recent reference value of 3.48 μg/dL for children 1–5 years old in the United States [42]. They are also consistent with reported BLLs of children in other countries during the twenty-first Century.…”

Section: Resultssupporting

confidence: 93%

Environmental injustice and childhood lead exposure in peri-urban (ger) areas of Darkhan and Erdenet, Mongolia

et al. 2019

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BackgroundThe ger (“tent city”) areas in Mongolia are a product of rapid urbanization and transitional economic development combine with lack of institutional, administrative and financial capacity of governments to cope with the pace. These areas have become traps for inequities in social and environmental services and the associated effects on human health. Disparities in childhood lead exposure in such communities are largely unexplored.MethodsWe measured the concentrations of lead in blood of children, aged 4–7 years, in Erdenet (Orkhon Province) and Darkhan (Darkhan-Uul Province), the second and third largest cities in Mongolia. A survey instrument was used to gather information on influencing factors on lead exposure and the Strengths and Difficulties Questionnaire (SDQ) was used to assess a spectrum of behavioral problems among the children.ResultsThe mean blood lead level (BLL) of children in the two cities was found to be 3.8 ± 2.6 μg/dL (range: < 1.5–17.2 μg/dL) and 27.8% of the children had BLLs ≥5 μg/dL. Average BLL of children in Erdenet (a mining center) was significantly higher than that for children in Darkhan, and there was statistically significant difference between average BLL of children who live in ger district (4.2 ± 2.8 μg/dL) compared to those of children in housing units within the city (3.2 ± 2.4 μg/dL). In spite of the low values, BLLs was significantly associated with a number of effects on the spectrum of behavioral disorders, specifically with the scores for hyperactivity, conduct disorder and pro-social behavior.ConclusionsThis study shows that childhood lead poisoning is common especially in ger communities of the urban areas of Mongolia. It contributes evidence showing that BLL low as 3.8 μg/dL can selectively activate some effects from a spectrum of likely behavioral disorders in children.

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Section: Resultssupporting

confidence: 93%

Environmental injustice and childhood lead exposure in peri-urban (ger) areas of Darkhan and Erdenet, Mongolia

et al. 2019

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“…24 However, capillary blood specimens may provide falsely elevated lead levels that can be the result of inappropriate blood collection procedures (e.g., finger stick collection from a lead-contaminated finger) or due to contaminated materials used to collect and transport the specimen. 5,25,26 Given that, in 2013, the CDC Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) recommended that blood lead levels greater than or equal to 5 μg/dL analyzed on POC instruments on children less than 6 years of age be confirmed using a venous blood sample analyzed by CLIA-certified high complexity method. 6 At that time, LeadCare II was (and still is) the only POC instrument approved for blood lead testing.…”

Section: Discussionmentioning

confidence: 99%

Response to the US FDA LeadCare Testing Systems Recall and CDC Health Alert

Mason

Ortiz

Pappas

et al. 2019

Journal of Public Health Management and Practice

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On May 17, 2017, the Food and Drug Administration (FDA) issued a safety recall for the Magellan Diagnostics’ LeadCare Testing Systems due to the potential for inaccurately low blood lead test results when used with venous blood samples, which has implications for the follow-up care of persons exposed to lead. Concurrent with the recall, the Centers for Disease Control and Prevention (CDC) issued a health alert regarding the use of LeadCare Testing Systems. CDC provided recommendations for specific high-risk populations so that persons potentially impacted by falsely low test results could be retested and receive appropriate follow-up care. Childhood lead poisoning prevention programs in state and local public health agencies collect blood lead test results for children and had a lead role in identifying children for retesting. CDC’s Lead Poisoning Prevention Program sought to understand how the recall and recommendations impacted state and local public health agencies. Case studies are presented that highlight the experiences of four state childhood lead poisoning prevention programs in responding to the recall and recommendations. Collectively, the case studies point to several lessons learned, including the importance of: (1) having a well-functioning surveillance system in place prior to a serious incident; (2) having a clear understanding of the roles partners play in the continuum of care for children potentially exposed to lead; (3) ensuring effective communications with all staff, both internal and external, to public health agencies that have a role in responding to a serious incident. The ability to respond to public health emergencies or other serious incidents takes the combined effort of federal, state, and local public health agencies as well as others in the healthcare delivery system. CDC will continue to support state and local lead poisoning prevention programs so they have the information and tools they need to address and prevent the health effects of lead exposures in communities.

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“…Most laboratories report the accuracy of their blood lead tests to be ±2 ug/dL, which is large considering that the current population mean is below 1 ug/dL (Caldwell et al 2017). Because our dependent variable is binary, measurement error can lead to inconsistent estimates (as well as within each state but did not match on the closest Superfund site.…”

Section: Econometric Approachmentioning

confidence: 98%

Superfund cleanups and children’s lead exposure

Klemick

Mason

Sullivan

2020

Journal of Environmental Economics and Management

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This study evaluates the effect of EPA's Superfund cleanup program on children's lead exposure. We linked two decades of blood lead level (BLL) measurements from children in six states with data on Superfund sites and other lead risk factors. We used quasi-experimental methods to identify the causal effect of proximity to Superfund cleanups on rates of elevated BLL. We estimated a difference-in-difference model comparing the change in elevated BLL of children closer to versus farther from lead-contaminated sites before, during, and after cleanup.We also estimated a triple difference model including children near hazardous sites with minimal to no lead contamination as a comparison group. We used spatial fixed effects and matching to minimize potential bias from unobserved differences between the treatment and comparison groups. Results indicate that Superfund cleanups lowered the risk of elevated BLL for children living within 2 kilometers of lead-contaminated sites 8 to 18 percent.

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Measurement Challenges at Low Blood Lead Levels

Cited by 58 publications

References 6 publications

Environmental injustice and childhood lead exposure in peri-urban (ger) areas of Darkhan and Erdenet, Mongolia

Environmental injustice and childhood lead exposure in peri-urban (ger) areas of Darkhan and Erdenet, Mongolia

Response to the US FDA LeadCare Testing Systems Recall and CDC Health Alert

Superfund cleanups and children’s lead exposure

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