Who tests for lead and why? A 10-year analysis of blood-lead screening, follow-up, and CNS outcomes in a statewide U.S. healthcare system

Details

• Alternative Title:
  Occup Environ Med
• Personal Author:
  Reuben, Aaron ; Ward, Ralph ; Rothbaum, Alex O. ; Cornelison, Vickey L. ; Huffman, Sarah ; McTeague, Lisa M. ; Schmidt, Michael G. ; Specht, Aaron J. ; Kilpatrick, Dean G.
• Description:
  Objectives.
  
  Determine: (1) which providers in U.S.-healthcare systems order lead tests, why, and at what frequency, and (2) whether current patient-population lead-levels are predictive of clinical outcomes.
  
  Methods.
  
  Retrospective medical-record study of all blood-lead tests in Medical University of South Carolina healthcare system 2012–2016 and consequent evidence of CNS-related disease across a potential 10-year-window (2012–2022).
  
  Results.
  
  Across 4 years, 9,726 lead-tests resulted for 7,181 patients (49.0% female; 0–94 years), representing 0.2% of the hospital population. Most tests were for young (76.6% ≤age 3) and non-Hispanic Black (47.2%) and Hispanic (26.7%) patients. A wide variety of providers ordered tests; however, most were ordered by pediatrics, psychiatry, internal medicine, and neurology. Lead-levels ranged from ≤2.0μg/dL (80.8%) to ≥10μg/dL (0.8%; max 36μg/dL). 201 children (3.1%) had initial lead-levels over the reference value for case-management at the time (5.0μg/dL). Many high-level children did not receive follow-up testing in the system (36.3%) and those that did often failed to see levels fall below 5.0μg/dL (80.1%). Non-Hispanic Black and Hispanic patients were more likely to see lead-levels stay high or go up over time. Over follow-up, children with high lead-levels were more likely to receive new ADHD and conduct disorder diagnoses and new psychiatric medications. No significant associations were found between lead-test results and CNS-diagnoses or medications among adults.
  
  Conclusions.
  
  Hospital lead-testing covers a small portion of patients but includes a wide range of ages, presentations, and provider-specialties. Lack of lead-decline among many pediatric patients suggests there is room to improve provider guidance around when to test and follow-up.
  
  
• Subjects:
  Child Child, Preschool Delivery Of Health Care Female Follow-Up Studies Humans Lead Lead Poisoning Male Retrospective Studies Risk Factors

  More +
• Keywords:
  ADHD Blood Lead Levels Health Equity Pediatric Lead Screening Preventive Medicine
• Source:
  Occup Environ Med. 81(2):101-108
• Pubmed ID:
  38272665
• Pubmed Central ID:
  PMC11099936
• Document Type:
  Journal Article
• Funding:
  F32 ES034238/ES/NIEHS NIH HHSUnited States/ ; K01 OH012528/OH/NIOSH CDC HHSUnited States/ ; P20 GM109040/GM/NIGMS NIH HHSUnited States/ ; T32 MH018869/MH/NIMH NIH HHSUnited States/
• Volume:
  81
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:6bb43f21327e200bd50ea4c51a03cd507f5a98f7a10b990ac688ae9fd5f7bf376c0970681f73e4802dcc686dbb0cd8cc415c2193b4f4a7d10f8152f73dd94ec9
• Download URL:
  https://stacks.cdc.gov/view/cdc/156912/cdc_156912_DS1.pdf
• File Type:
  [PDF - 635.00 KB ]