More Guidelines than states: variations in U.S. lead screening and management guidance and impacts on shareable CDS development

Michel, Jeremy J.; Erinoff, Eileen; Tsou, Amy Y.

doi:10.1186/s12889-020-8225-8

Cited by 10 publications

(6 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This finding may have clinical implications, as this study as well as a recent national study has demonstrated increased risk of detectable and elevated blood lead levels after 24 months of age. 35 There is currently great variability between individual states and CDC guidance on the frequency and at what ages to conduct universal or targeted blood lead testing. 6,35 Lastly, we were not able to identify an etiology for the increase in the proportion of BLL ≥ 5 µg/dL (Fig.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Neighborhood disparities and the burden of lead poisoning

et al. 2023

View full text Add to dashboard Cite

BACKGROUND: To assess the persistence of neighborhood-level lead poisoning disparities in Rhode Island. METHODS: Rhode Island Department of Health blood lead levels (BLL) collected from 2006-2019 were linked to census block group rates of poverty and housing built pre-1950. We computed multivariate logistic regression models of elevated BLLs (≥5 µg/dL and ≥10 µg/dL). RESULTS: Of the 197,384 study children, 12.9% had BLLs ≥5 µg/dL and 2.3% had BLLs ≥10 µg/dL. The proportion of children with BLL ≥ 5 µg/dL increased across quintiles of poverty and old housing. The odds ratio for highest quintiles was 1.44 (95% CI: 1.29, 1.60) and 1.92 (95% CI: 1.70, 2.17) for poverty and pre-1950 housing, respectively. A significant temporal decline was observed for BLL ≥ 5 µg/dL (2006: 20.5%, 2019: 3.6%). Disparities narrowed over the study period across quintiles of poverty and old housing with a similar trend appearing in the proportion of children with BLL ≥ 10 µg/dL. CONCLUSION: Despite tremendous progress in reducing lead exposure, substantial neighborhood disparities in lead poisoning persist. These findings provide valuable considerations for primary childhood lead exposure prevention.

show abstract

Section: Discussionmentioning

confidence: 99%

“…35 There is currently great variability between individual states and CDC guidance on the frequency and at what ages to conduct universal or targeted blood lead testing. 6,35 Lastly, we were not able to identify an etiology for the increase in the proportion of BLL ≥ 5 µg/dL (Fig. 5) in 2009.…”

Section: Discussionmentioning

confidence: 99%

Neighborhood disparities and the burden of lead poisoning

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Early identification of children with lead exposure can help identify and eliminate lead sources (and future exposures for other children); reduce their BLL over time; and link children with high BLLs to medical, nutritional, and educational services. Medicaid-enrolled children are required to be screened at ages 12 and 24 months; many states have additional screening requirements (4).…”

mentioning

confidence: 99%

Decreases in Young Children Who Received Blood Lead Level Testing During COVID-19 — 34 Jurisdictions, January–May 2020

Courtney

Chuke

Dyke

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

View full text Add to dashboard Cite

Exposure to lead, a toxic metal, can result in severe effects in children, including decreased ability to learn, permanent neurologic damage, organ failure, and death. CDC and other health care organizations recommend routine blood lead level (BLL) testing among children as part of well-child examinations to facilitate prompt identification of elevated BLL, eliminate source exposure, and provide medical and other services (1). To describe BLL testing trends among young children during the coronavirus disease 2019 (COVID-19) pandemic, CDC analyzed data reported from 34 state and local health departments about BLL testing among children aged <6 years conducted during January-May 2019 and January-May 2020. Compared with testing in 2019, testing during January-May 2020 decreased by 34%, with 480,172 fewer children tested. An estimated 9,603 children with elevated BLL were missed because of decreased BLL testing. Despite geographic variability, all health departments reported fewer children tested for BLL after the national COVID-19 emergency declaration (March-May 2020). In addition, health departments reported difficulty conducting medical follow-up and environmental investigations for children with elevated BLLs because of staffing shortages and constraints on home visits associated with the pandemic. Providers and public health agencies need to take action to ensure that children who missed their scheduled blood lead screening test, or who required follow-up on an earlier high BLL, be tested as soon as possible and receive appropriate care. CDC identifies no safe BLL in children and considers a blood lead reference value (BLRV) of 5.0 µg/dL* sufficient to prompt clinical and public health intervention (1,2). Among children aged <6 years, very high BLL (>70 µg/dL) can cause neurologic problems (e.g., seizures or coma), organ failure, and death. Lower, but still elevated, BLL can affect the nervous system, causing permanent neurologic damage, behavioral disorders, and cognitive impairment (1). In the United States, the most common childhood lead exposures are from lead-based paint * CDC uses a BLRV of 5.0 µg/dL to identify children with blood lead levels that are higher than those of most children. The BLRV is based on the 97.5th percentile of the NHANES blood lead distribution in children aged 1-5 years.

show abstract

“…As of 2020, in 43 states, 52 medical health care workers and medical facilities are required to report all child BLL results to state agencies for surveillance purposes. In the remaining states, reporting is based on a state‐defined benchmark.…”

Section: Summary Of Current Child Bll Testing Practicesmentioning

confidence: 99%

Improving Equitability and Inclusion for Testing and Detection of Lead Poisoning in US Children

Sobin¹,

Gutiérrez-Vega

Flores-Montoya

et al. 2023

Milbank Quarterly

View full text Add to dashboard Cite

Child lead poisoning is associated with socioeconomic inequity and perpetuates health inequality. Methods for testing and detection of child lead poisoning are ill suited to the current demographics and characteristics of the problem. A three‐pronged revision of current testing approaches is suggested. Employing the suggested revisions can immediately increase our national capacity for equitable, inclusive testing and detection. Abstract Child lead poisoning, the longest‐standing child public health epidemic in US history, is associated with socioeconomic inequity and perpetuates health inequality. Removing lead from children's environments (“primary prevention”) is and must remain the definitive solution for ending child lead poisoning. Until that goal can be realized, protecting children's health necessarily depends on the adequacy of our methods for testing and detection. Current methods for testing and detection, however, are no longer suited to the demographics and magnitude of the problem. We discuss the potential deployment and feasibility of a three‐pronged revision of current practices including: 1) acceptance of capillary samples for final determination of lead poisoning, with electronic documentation of “clean” collection methods submitted by workers who complete simple Centers for Disease Control and Prevention–endorsed online training and certification for capillary sample collection; 2) new guidance specifying the analysis of capillary samples by inductively coupled plasma mass spectrometry or graphite furnace atomic absorption spectrometry with documented limit of detection ≤0.2 μg/dL; and 3) adaptive “census tract–specific” universal testing and monitoring guidance for children from birth to 10 years of age. These testing modifications can bring child blood lead level (BLL) testing into homes and communities, immediately increasing our national capacity for inclusive and equitable detection and monitoring of dangerous lower‐range BLLs in US children.

show abstract

More Guidelines than states: variations in U.S. lead screening and management guidance and impacts on shareable CDS development

Cited by 10 publications

References 39 publications

Neighborhood disparities and the burden of lead poisoning

Neighborhood disparities and the burden of lead poisoning

Decreases in Young Children Who Received Blood Lead Level Testing During COVID-19 — 34 Jurisdictions, January–May 2020

Improving Equitability and Inclusion for Testing and Detection of Lead Poisoning in US Children

Contact Info

Product

Resources

About