Despite efforts to remove lead from many products, such as gasoline and paint, some children in the United States are still at risk for lead poisoning. A new study shows that children at the greatest risk for lead poisoning, and also those identified with elevated blood lead levels through screening, were the least likely to get follow-up testing needed for prevention.
In the first population-based study of its kind, researchers from the University of Michigan Health System's Child Health Evaluation and Research (CHEAR) Unit found that only 53.9 percent of children in Medicaid with elevated blood lead levels identified through screening got the necessary follow-up testing to prevent lead poisoning, and of those children, nearly half still had elevated blood lead levels.
The results of this study are published in the May 11, 2005 issue of the Journal of the American Medical Association (JAMA).
Significant efforts have been made by the Centers for Disease Control and Prevention and state health departments to improve blood lead screening among 1- to 5-year-old children at the greatest risk for lead poisoning – those enrolled in Medicaid or other public assistance program, or living in communities known to have higher levels of lead in the environment.
But screening is only one step in the process to prevent lead poisoning, which even at low levels can impair cognitive development and cause anemia, says lead author Alex R. Kemper, M.D., MPH, a member of the CHEAR team in the U-M Division of General Pediatrics.
"Screening children for lead is so important because its symptoms are not physical. But it's only effective with appropriate follow-up testing," says Kemper, an assistant professor of pediatrics at the U-M Medical School. "Follow-up testing is the cornerstone of lead poisoning management and an essential component of secondary prevention, and kids aren't making it to that necessary next step."
Using a group of 3,682 Michigan Medicaid-enrolled children under the age of 6 with an elevated blood lead level screening, Kemper and his team set out to determine if children were receiving the necessary follow-up testing within 180 days of their screening. The six-month interval following an elevated screening is critical to determine if blood lead levels are increasing and if the child is responding to any medical intervention.
The study was based in Michigan since the state has a reporting mechanism for all blood lead levels, and compared to other states, Michigan has a higher number of children with lead poisoning.
Most children in the study were Hispanic or non-white, lived in urban areas and had a high risk of lead exposure. More than half in the study were 1-year-old and 2-year-old children.
The study found that a little more than half (53.9 percent) of the children received follow-up testing. Of those who had follow-up testing, testing occurred an average of 69 days after screening revealed the elevated blood lead level, and 47.5 percent continued to have an elevated blood lead level.