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
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2 02 2024
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Source: Occup Environ Med. 81(2):101-108
Details:
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Alternative Title:Occup Environ Med
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Personal Author:
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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.
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Pubmed ID:38272665
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Pubmed Central ID:PMC11099936
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Supporting Files:No Additional Files