Who Tests for Lead and Why? A 10-Year Analysis of Blood Lead Screening, Follow-Up and CNS Outcomes in a Statewide US Healthcare System

Details

• Personal Author:
  Cornelison VL ; Huffman S ; Kilpatrick DG ; McTeague LM ; Reuben A ; Rothbaum AO ; Schmidt MG ; Specht AJ ; Ward R
• Description:
  Objectives: This study aims to determine (1) which providers in US 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 the Medical University of South Carolina healthcare system 2012-2016 and consequent evidence of central nervous system (CNS)-related disease across a potential 10-year window (2012-2022). Results: Across 4 years, 9726 lead tests resulted for 7181 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 ≤2.0 µg/dL (80.8%) to ≥10 µg/ dL (0.8%; max 36 µg/dL). 201 children (3.1%) had initial lead levels over the reference value for case management at the time (5.0 µg/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 5.0 µg/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 attention-deficit/ hyperactivity disorder and conduct disorder diagnoses and new psychiatric medications. No significant associations were found between lead test results and new 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. [Description provided by NIOSH]
• Subjects:
  Epidemiology Occupational Health Safety
• Keywords:
  Blood Lead Levels Central Nervous System Disorders Clinical Tests Medical Screening
• ISSN:
  1351-0711
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Georgia ; Indiana ; North Carolina ; OSHA Region 4 ; OSHA Region 5 ; South Carolina
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  101-108
• Volume:
  81
• Issue:
  2
• NIOSHTIC Number:
  nn:20069189
• Citation:
  Occup Environ Med 2024 Feb; 81(2):101-108
• Contact Point Address:
  Dr Aaron Reuben, Duke University, Durham, North Carolina
• Email:
  aaron.reuben@duke.edu
• CAS Registry Number:
  Lead (CAS RN 7439-92-1)
• Federal Fiscal Year:
  2024
• Performing Organization:
  Purdue University
• Peer Reviewed:
  True
• Start Date:
  20210901
• Source Full Name:
  Occupational and Environmental Medicine
• End Date:
  20220731
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:671804b82f68d6a412ae4e6593d9e37807df2e30606128adb76b09d90ba2e03bb918e5f0ec1236dbd3f66fc7695c644adb251950a122af9b4e75a9d076f9aa50
• Download URL:
  https://stacks.cdc.gov/view/cdc/207721/cdc_207721_DS1.pdf
• File Type:
  [PDF - 793.45 KB ]