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© 2022. This work is published under Reproduced from Environmental Health Perspectives (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Background: No safe level of lead in blood has been identified. Blood lead testing is required for children on Medicaid, but it is at the discretion of providers and parents for others. Elevated blood lead levels (EBLLs) cannot be identified in children who are not tested. Objectives: The aims of this research were to identify determinants of lead testing and EBLLs among North Carolina children and estimate the num-ber of additional children with EBLLs among those not tested. Methods: We linked geocoded North Carolina birth certificates from 2011-2016 to 2010 U.S. Census data and North Carolina blood lead test results from 2011-2018. We estimated the probability of being screened for lead and created inverse probability (IP) of testing weights. We evaluated the risk of an EBLL of >3 Ug=dL at <30 months of age, conditional on characteristics at birth, using generalized linear models and then applied IP weights to account for missing blood lead results among unscreened children. We estimated the number of additional children with EBLLs of all North Carolina children using the IP-weighted population and bootstrapping to produce 95% credible intervals (CrI). Results: Mothers of the 63.5% of children (402,002 of 633,159) linked to a blood lead test result were disproportionately young, Hispanic, Black, American Indian, or on Medicaid. In full models, maternal age <20 y [riskratio (RR) = 1:10; 95% confidence interval (CI): 1.13, 1.20] or smoking (RR = 1.14; 95% CI: 1.12, 1.17); proximity to a major roadway (RR = 1.10; 95% CI: 1.05, 1.15); proximity to a lead-releasing Toxics Release Inventory site (RR= 1.08; 95% CI: 1.03, 1.14) or a National Emissions Inventory site (RR = 1.11; 95% CI: 1.07, 1.14); and living in neighborhoods with more housing built before 1950 (RR = 1.10; 95% CI: 1.05, 1.14) or before 1940 (RR=1.18; 95% CI: 1.11, 1.25) or more vacant housing (RR = 1.14; 95% CI: 1.11, 1.17) were associated with an increased risk of EBLL, whereas overlap with a public water service system was associated with a decreased risk of EBLL (RR = 0.85; 95% CI: 0.83, 0.87). Children of Black mothers were no more likely than children of White mothers to have EBLLs (RR = 0.98; 95% CI: 0.96, 1.01). Complete blood lead screening in 2011-2018 may have identified an additional 17,543 (95% CrI: 17,462, 17,650) children with EBLLs >3 itg=dL. Discussion: Our results indicate that current North Carolina lead screening strategies fail to identify over 30% (17,543 of 57,398) of children with subclin-ical lead poisoning and that accounting for characteristics at birth alters the conclusions about racial disparities in children's EBLLs.

Details

Title
Patterns of Children's Blood Lead Screening and Blood Lead Levels in North Carolina, 2011-2018-Who Is Tested, Who Is Missed?
Author
Kamai, Elizabeth M 1 ; Daniels, Julie L 1 ; Delamater, Paul L 2 ; Lanphear, Bruce P 3 ; MacDonaldGibson, Jacqueline 4 ; Richardson, David B

 Department of Epidemiology, University of North Carolina at Chapel Hill (UNC-Chapel Hill), Chapel Hill, North Carolina, USA 
 Department of Geography, UNC-Chapel Hill, Chapel Hill, North Carolina, USA 5Carolina Population Center, UNC-Chapel Hill, North Carolina, USA 
 Department of Environmental and Occupational Health, Indiana University, Bloomington, Indiana, USA 
 Department of Environmental and Occupational Health, University of California, Irvine, California, USA 
Pages
1-16
Publication year
2022
Publication date
Jun 2022
Publisher
National Institute of Environmental Health Sciences
e-ISSN
15529924
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3172287864
Copyright
© 2022. This work is published under Reproduced from Environmental Health Perspectives (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.