Blood Lead Levels in a Continuity Clinic Population

• Published in: Clinical toxicology (Philadelphia, Pa.) Pa.), 1997, Vol.35 (2), p.181-186
• Main Authors: Holmes, Susan E., Drutz, Jan E., Buffone, Gregory J., Rice, Teresa Duryea
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Chemical and industrial products toxicology. Toxic occupational diseases; Child; Child, Preschool; Continuity of Patient Care; Female; Humans; Infant; Internship and Residency; Lead - adverse effects; Lead - blood; Male; Medical sciences; Metals and various inorganic compounds; Outpatient Clinics, Hospital; Primary Health Care; Risk Assessment; Surveys and Questionnaires; Toxicology; Urban Population
• ISSN: 1556-3650; 0731-3810; 1556-9519; 1097-9875
• DOI: 10.3109/15563659709001190

Abstract Introduction: Lead toxicity is well recognized as a significant cause of morbidity in children, especially those under the age of six years. While lead toxicity has not been recognized as a public health problem in Houston, it is possible that children in the area suffer from low-level lead effect on the central nervous system. Objectives: To detect asymptomatic cases of lead toxicity in one population of Houston children and to assess the effectiveness of the lead risk questionnaire. Design: Venous blood samples for quantitative lead were analyzed utilizing the Anodic Stripping Voltameter. The Centers for Disease Control's lead risk assessment questionnaire was administered to each patient. Setting: Baylor College of Medicine Continuity Clinic at Texas Children's Hospital. Subjects: All patients, age 9-72 months, seen for routine care between December 1992 and June 1994 were screened once. Results: Blood lead levels were obtained on 801 children; all but 47 completed lead risk questionnaires. The mean age of the study group was 2.37 years (SD 1.84) and they were 54% male. They were 39% Hispanic, 39% Black, and 18% White. Eighty-eight percent reported an annual income of >$20,000. They lived in 127 separate zip codes. Twenty-five (3.1%) patients had elevated blood lead, 21 between 10-14 μ/dL and 4 between 15-19 μ/dL. No patients had blood lead levels of 20μ/dL. No statistically significant differences were found between patients with blood lead > 10μ/dL and those with 10μ/dL when comparing for age, sex, ethnicity, income, and zip code. Only those children living in or regularly visiting a pre-1960 home with peeling or chipping paint were significantly more likely to have elevated blood lead (p=. 045). Conclusion: Although the majority of children in our setting were poor and urban, the prevalence of blood lead > 10 μ/dL was 3.1%, well below the estimated 17% quoted by the Centers for Disease Control in recommending stringent screening guidelines. The lead risk assessment questionnaire failed to identify 32% of children with elevated blood lead levels. Since this questionnaire is critical to screening populations at low risk for lead toxicity, it is important to determine whether a revised questionnaire or a more careful elicitation of parental responses will improve identification of those children at risk