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Childhood Lead Poisoning in New York State
Symposium To Examine Lead Poisoning in NYSMarch 13, 2006
Rachel de Long, M.D., M.P.H.Director, Bureau of Child and Adolescent Health
NYS Department of Health
Childhood Lead Poisoning: A preventable public health problem Lead poisoning defined as a blood lead level
> 10 mcg/dL Recent research suggests may be no ‘safe’ level
of lead Level of intervention varies by blood lead level,
consistent with evidence of effectiveness Tremendous progress in lowering prevalence
and severity of childhood lead poisoning over past several decades
Childhood Lead Poisoning: A preventable public health problem Elevated blood lead levels (EBLLs) associated with
range of negative outcomes Cognitive deficits Behavioral problems Anemia Diminished bone growth Dental caries Hypertension Osteoporosis Poor pregnancy outcomes
Factors associated with lead poisoning Young Children are at highest risk for lead
poisoning BLLs typically rise between 6-12 months and
peak between 18-36 months of age Consistent with normal child development:
Increased mobility Active exploration of environment Hand-to-mouth behavior Efficient GI absorption of lead vs. adults
Factors associated with lead poisoning Other Individual Factors
Developmental factors Hand-to-mouth behaviors Pica
Nutritional status Iron and calcium deficiency
Hobbies/occupation Use of contaminated consumer products Practice of protective behaviors
Factors associated with lead poisoning Community Level Factors
Age and condition of housing Deteriorating paint Disturbance of intact paint (renovation/remodeling)
Poverty/socioeconomic status Racial minority populations Immigrant/refugee populations Community-specific exposures (e.g. industry)
Sources of lead exposure Deteriorating paint (chips or dust) Soil (deposits from leaded gasoline, paint,
industry) Water (lead plumbing) Traditional remedies, cosmetics, consumer
products Occupational and hobby exposures Industry
Factors associated with lead poisoning: NYS Data New York State has the highest percent of pre-1950
housing in nation 55% of housing in New York City †
40% of housing in Upstate New York †
Children living in poverty 26% of children in NYC live below the federal poverty
level (FPL) †
14% of Upstate children live below FPL †
36% of Upstate children are eligible for Medicaid in 2004.
WIC Eligibility 40% of all NYS children were enrolled in WIC in 2005.
† 2000 Census
Factors associated with lead poisoning: NYS Data Non-white minority children
77% of children in NYC were identified as non-white by their parents or guardians. †
23% of Upstate children were identified as non-white by their parents or guardians. †
Foreign-born children represent 23% of all NYS children. Over 10,000 refugees entered NYS in 1999
† 2000 Census
NYS: Lead Screening of Children
NYS Lead Screening Requirements Universal blood lead testing at or around age 1 year and 2
years Annual risk assessment, with blood lead testing as
indicated, up to age six years Assessment of lead screening status on enrollment in child
care/preschool, with referral and education as needed Screening is essential for:
Identification and follow-up of individual children with lead poisoning
State and local level surveillance and program planning
NYS Data: Lead Screening Rates Initial Test Data
67.6% children outside of NYC received at least one blood lead test by 24 months of age (2001 birth cohort) Increase of 5% since 1996
66% of children in NYC received at least one lead test by age one year 84% of children in NYC had at least one lead test before their
third birthday (2000 birth cohort)
74% of children enrolled in Medicaid Managed Care tested at least once by age 24 months Nationally, only 43% of Medicaid-eligible children ever receive
a blood lead screening test
NYS Data: Lead Screening Rates Second Test Data
Of those upstate children with non-elevated initial screening test, 32% received a second lead test (1996-2000 data)
30% NYC children received blood lead test at both 12 and 24 months of age (2000 birth cohort)
Figure 1: Number* and Percent of Children First Screened for Elevated Blood Lead Levels Before Age 24 months, by Birth Year Cohort:
New York State excluding New York City Supplemental Report
88,75988,124
85,21085,864
91,582
88,146
67.6
62.661.7
64.862.2
72,500
77,500
82,500
87,500
92,500
1996 1997 1998 1999 2000 2001
Birth Cohort
Nu
mb
er o
f C
hil
dre
n F
irst
Scr
een
ed
20
40
60
80
100
Pe
rce
nt o
f Ch
ildre
n S
cre
en
ed
Number of Children First Tested for Blood Lead Level Screening Rate per 100 Children
66.6
NYS Data: Prevalence of Lead Poisoning Prevalence- total number of children with lead
poisoning during a specific time Prevalent cases, 10-19 mcg/dL in Upstate NY
4,140 (2.3 cases/100 tests) This is a 28% decrease since 2000
Prevalent cases, 20+ mcg/dL in Upstate NY 413 (0.2 cases/100 tests) This is a 35% decrease since 2000
NYS Data: Incidence of lead poisoning Incidence: newly identified children with elevated
blood lead levels
2003 data NYC Upstate NY
Incident cases 10-19 3,413 2,383
Incident rate 10-19 1.1/100 tests* 1.3/100 tests
Trends 82% decrease since 1995 24% decrease from 2000
Incident cases >20 473 422
Incident rate >20 No rate available 0.2/100 tests23% decrease since 2000
* NYC rates are based on tests of children 0-18 years of age
Figure 3: Number and Rates of Children Newly Identified with Blood Lead Levels > 10ug/dL
New York State excluding New York CitySupplemental Report
5,491
4,547
3,682
3,3483,175
2,805
1.61.7
1.8
2.0
2.5
2.9
0
1000
2000
3000
4000
5000
6000
1998 1999 2000 2001 2002 2003
Year of Test
Nu
mb
er N
ewly
Id
enti
fied
0
0.5
1
1.5
2
2.5
3
3.5
Inci
den
ce R
ate
Number of Children Newly Identified Incidence Rate > 10ug/dL
Lead Poisoning is not evenly distributed across the state 36 high-incidence upstate zip codes account for over
40% of the new cases of EBLL outside NYC (2000-2001 data) Zip codes with >5% incidence rate EBLLs 2% of all upstate zip codes Urban neighborhoods characterized by higher rates of
poverty and pre-1950 housing 18 high-incidence neighborhoods account for more
than 73% of new cases of EIBLL (>15mcg/dL) in NYC Brooklyn has 10 of 11 neighborhoods with EIBLL rates
higher than the citywide incidence rate.
Success in targeting screening promotion efforts High-incidence communities have higher lead
screening rates Previous study showed that 80% of children in
high-incidence upstate zip codes screened vs. 61% of all children screened over same time period (1994-97 birth cohorts)
Seven of NYC highest-incidence neighborhoods also have higher than NYC- average screening rate
Haley VB., & Talbot TO. (2004) Geographic analysis of blood lead levels in New York State children born 1994-1997. Environmental Health Perspectives, 112(15): 1577-1582.
Lead Poisoning distribution in NYS, by county, 1999-2001
High Incidence rate Zip Codes, 2001
High-incidence rates in NYC, 2003
Elimination of Childhood Lead Poisoning by 2010 Healthy People Goal: Elimination of Childhood
Lead Poisoning by 2010 NYS Plan for the Elimination of Childhood Lead
Poisoning by 2010 Released June 2004 Complements NYC Elimination Plan
Plan provides a framework for lead elimination work of NYSDOH and partners Living document informed by ongoing input from
multiple stakeholders and success of elimination activities
Public Health Approach to Elimination of Childhood Lead Poisoning Surveillance Screening Follow-up/management of EBLLs: education,
nursing, environmental Primary Prevention Targeting High-Risk Populations Strategic Partnerships
Questions and Discussion