There is no safe detectable level of lead (Pb) in the blood of young children. In the United States, predominantly African-American Black children are exposed to more Pb and present with the highest mean blood lead levels (BLLs). However, racial disparity has not been fully examined within risk factors for early childhood Pb exposure. Therefore, we conducted secondary analysis of blood Pb determinations for 2841 US children at ages 1-5 years with citizenship examined by the cross-sectional 1999 to 2010 National Health and Nutrition Examination Survey (NHANES). The primary measures were racial disparities for continuous BLLs or an elevated BLL (EBLL) ≥5 µg/dL in selected risk factors between non-Hispanic Black children (n = 608) and both non-Hispanic White (n = 1208) or Hispanic (n = 1025) children. Selected risk factors included indoor household smoking, low income or poverty, older housing built before 1978 or 1950, low primary guardian education <12th grade/general education diploma (GED), or younger age between 1 and 3 years. Data were analyzed using a regression model corrected for risk factors and other confounding variables. Overall, Black children had an adjusted +0.83 µg/dL blood Pb (95% CI 0.65 to 1.00, p < 0.001) and a 2.8 times higher odds of having an EBLL ≥5 µg/dL (95% CI 1.9 to 3.9, p < 0.001). When stratified by risk factor group, Black children had an adjusted 0.73 to 1.41 µg/dL more blood Pb (p < 0.001 respectively) and a 1.8 to 5.6 times higher odds of having an EBLL ≥5 µg/dL (p ≤ 0.05 respectively) for every selected risk factor that was tested. For Black children nationwide, one in four residing in pre-1950 housing and one in six living in poverty presented with an EBLL ≥5 µg/dL. In conclusion, significant nationwide racial disparity in blood Pb outcomes persist for predominantly African-American Black children even after correcting for risk factors and other variables. This racial disparity further persists within housing, socio-economic, and age-related risk factors of blood Pb outcomes that are much more severe for Black children.

/pdf/disparity-in-risk-factor-severity-for-early-childhood-blood-2834gonpyl.pdf

Disparity in Risk Factor Severity for Early Childhood Blood Lead among Predominantly African-American Black Children: The 1999 to 2010 US NHANES

Childhood lead poisoning is a serious public health problem with long-term adverse effects. Healthy People 2020's environmental health objective aims to reduce childhood blood lead levels; however, efforts may be hindered by potential racial/ethnic differences. Recent recommendations have lowered the blood lead reference level. This review examined racial/ethnic differences in blood lead levels among children under 6 years of age. We completed a search of PubMed, CINAHL, and PsycINFO databases for published works from 2002 to 2012. We identified studies that reported blood lead levels and the race/ethnicity of at least two groups. Ten studies met inclusion criteria for the review. Blood lead levels were most frequently reported for black, white, and Hispanic children. Six studies examined levels between blacks, whites, and Hispanics and two between blacks and whites. Studies reporting mean lead levels among black, whites, and Hispanics found that blacks had the highest mean blood lead level. Additionally, studies reporting blood lead ranges found that black children were more likely to have elevated levels. Studies suggest that black children have higher blood lead levels compared to other racial/ethnic groups. Future studies are warranted to obtain ample sample sizes for several racial/ethnic groups to further examine differences in lead levels.

Racial/Ethnic Differences in Childhood Blood Lead Levels Among Children <72 Months of Age in the United States: a Systematic Review of the Literature

Therapeutic efficiency of succimer used with calcium and ascorbic acid in the treatment of mild lead-poisoning.

Declining blood lead levels and cognitive changes in moderately lead-poisoned children

Introduction. In 2006, a Peruvian environmental agency reported the presence of elevated blood lead levels (BLLs) in indigenous communities of the Corrientes river basin. This is a territory in the ...

/pdf/lead-exposure-in-indigenous-children-of-the-peruvian-amazon-3wd8bp3m43.pdf

Lead exposure in indigenous children of the Peruvian Amazon : seeking the hidden source,venturing into participatory research

Studies reporting an inverse relationship between children’s blood lead levels (BLLs) of 10–24 μg/dL and cognitive function/performance (Bellinger et al. 1991; Ruff et al. 1993) motivated the Centers for Disease Control and Prevention (CDC) to lower the level of concern from a BLL ≥ 25 μg/dL to ≥ 10 μg/dL in 1991 (CDC 1991). Although prevention efforts have resulted in an 86% decline in BLLs ≥ 10 μg/dL in children in the United States from the 1970s to the present, an estimated 310,000 children < 6 years of age still have BLLs ≥ 10 μg/dL (Schwemberger et al. 2005). A key prevention strategy has been to identify children with BLLs ≥ 10 μg/dL and to enroll them in case management to reduce their lead burdens.

Collecting blood lead is considered to be the most useful tool for screening and diagnostic testing (Agency for Toxic Substances and Disease Registry 2005). Blood lead levels correlate most closely with recent environmental exposure. The excretory half-life of lead in adult blood is approximately 36 days (Todd et al. 1996), but estimates in children are longer (Manton et al. 2000). Prolonged exposure, which can come from both internal and external sources, prevents BLLs from declining to lower levels. The most common external source of exposure in children is deteriorated lead-based paint dust (CDC 1997). The most common internal exposure source is from lead reservoirs in bone, which are the largest component of body burden, accounting for 70% of all lead in children, and from where replenishment of lead in the blood occurs. Half-life of lead in bone is usually measured in years or even decades (Graziano 1994).

Although identification of the factors influencing the time to reduce a child’s BLL is essential to improving case management, few studies have investigated this issue. New York City investigators estimate that, on average, it takes 6–12 months for children’s BLLs to decline from ≥ 20 μg/dL to < 10 μg/dL, when medical and environmental management is consistent with CDC recommendations for managing children with elevated BLLs (Matte T, personal communication).

An analysis of Wisconsin surveillance data from 1995 to 1997 showed that BLLs decreased 2.6 μg/dL per year, and the mean time for decline among children with confirmed BLLs ≥ 20 μg/dL to drop below 10 μg/dL was just over 4 years (Wisconsin Childhood Lead Poisoning Prevention Program, unpublished data). A study published in 2001 found that those with higher peak BLLs take longer to decline to < 10 μg/dL (Roberts et al. 2001). Specifically, children with BLLs of 25–29 μg/dL required on average 24 months to fall below 10 μg/dL compared with children with BLLs of 10–14 μg/dL, who required 9.2 months. However, those findings may have been biased because the analysis did not take into account the contribution of children whose BLLs did not fall below 10 μg/dL. A more recent study reported times of decline of 11.6 months in the 10–14 μg/dL category and 12.7 months in the 15–19 μg/dL category among 2,109 children ≤ 3 years of age from six states enrolled in case management; however, the authors also excluded children who were censored in their analysis (Whitehead and Leiker 2007).

To assess factors related to the time required for children’s BLLs ≥ 10 μg/dL to decline, we analyzed routinely collected blood lead surveillance data from lead poisoning prevention programs in Vermont and North Carolina. We compared three different analytic approaches: a) a central analysis that included censoring children whose BLLs did not fall below 10 μg/dL at the time of their last test; b) an analysis that simply excluded children who were censored; and c) a sensitivity analysis that inferred the time for children’s BLLs to fall below 10 μg/dL on the basis of linear interpolations between the times of the last measurement above and the first measurement below the level of concern.

Reduction of elevated blood lead levels in children in North Carolina and Vermont, 1996-1999.

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Reduction of elevated blood lead levels in children in North Carolina and Vermont, 1996-1999.