Soil and lead poisoning Mary Jo Trepka, MD, MSPH.
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Transcript of Soil and lead poisoning Mary Jo Trepka, MD, MSPH.
Outline
• Importance of childhood lead poisoning
• Childhood lead poisoning in Miami-Dade County
• Risk factors in Miami-Dade County
• Health department services
• Relevance to students
• What we still don’t know
What is so important about childhood lead poisoning?
• Can lead to permanently lowered IQs
• Children more susceptible
• Ubiquitous in environment
• Urban poor and minorities disproportionately affected
What is a safe lead level?
• Current action level = 10 μg/dL
• Estimated 2.6-5.8 point IQ decline for increase from 10 to 20 μg/dL
• Under 10 μg/dL safe? – 7.4 point IQ decline for 1-10 μg/dL– Cognitive and academic deficits for BLL <
5 μg/dL
(Schwartz, et al, Env Res 1994, Bellinger, et al Pediatrics 1992, Canfield, et al NEJM 2003, Lanphear, et al Pub Health Rep 2000)
What is so important about childhood lead poisoning?
• Can lead to permanently lowered IQs
• Children more susceptible
• Ubiquitous in environment
• Urban poor and minorities disproportionately affected
What is so important about childhood lead poisoning?
• Can lead to permanently lowered IQs
• Children more susceptible
• Ubiquitous in environment
• Urban poor and minorities disproportionately affected
Occupations with possible lead exposure
• Auto repair/radiator repair• Painting• Construction work• Steel welding and cutting• Plumbing• Police work• Maritime industry
Hobbies with possible lead exposure
• Fishing sinkers• Working with cars, car parts, or car batteries• Painting• Stained-leaded glass work• Shooting guns at firing ranges• Working with model cars or boats• Pottery work
What is so important about childhood lead poisoning?
• Can lead to permanently lowered IQs
• Children more susceptible
• Ubiquitous in environment
• Urban poor and minorities disproportionately affected
NHANES blood lead levels among children aged 1-5 years, United States, 1976-2000
Year Geometric mean BLLS
Prevalence BLLs
> 10 μg/dL
Estimated no. children with BLLs > 10 μg/dL
1976-80 14.9 88.2% 13.5 million
1988-91 3.6 8.6% 1.7 million
1991-94 2.7 4.4% 0.9 million
1999-2000
2.2 2.2% 0.4 million
Source: CDC MMWR 2003;52:SS10
Prevalence of lead poisoning by housing age
• Nationwide 2.2 % of 1-5 year-olds• Housing
• 8.6% Pre-1946• 4.6% 1946-73• 1.6% Post-1973
Source: CDC, 1999-2000 NHANES
Prevalence of lead poisoningby race/ethnicity and income among
those in pre-1946 housing
• Differs by race/ethnicity• 22% black• 13% Mexican American• 6% white
• Differs by income• 16% low• 4% middle• 1% high
Source: CDC, 1999-2000 NHANES
Childhood lead poisoning in Miami-Dade County
• Prevalence– Florida: 3.2% (Hopkins, et al, J Fla Med Assoc.
1995)– Miami-Dade
• Countywide: unknown • Central urban area: estimated 8%
• Surveillance: average 431 cases a year among children (1998-2002)
• Underscreening– Florida 17% (GAO Report)– Miami-Dade 23% (analysis of Medicaid data)
Lead poisoning cases by gender, Miami-Dade County – 2002
63%
37% Male
Female
Source: Miami-Dade County Health Department, Vital and Morbidity Statistics 2002
Un-known
5%
Non-His-panic White
3%
Haitian20%
African Ameri-
can22%
His-panic50%
His-panic48%
African Ameri-
can/Haitian
25%
Non-His-
panic White23%
Other4%
Population < 6 years, 2000, and reported lead poisoning cases by race and ethnicity, 1999-2001, Miami-Dade County
Population Cases
Source: 2000 US Census and Miami-Dade County Health Department
Sources of lead hazards based on environmental home inspections
Lead Hazards found in Environmental Home Inspections 1999-2003 (N=188)
3127 28
22
16
6 7
13
05
101520253035
Sources of Lead Hazards
Num
ber
of H
azar
ds
• 188 inspections• 89 (47%)
inspections found no hazards (55 of these inspections in imported cases)
• ‘Other sources’: fishing weights, parental occupations, hobbies, water, objects/statues
Source: Miami-Dade County Health Department Childhood Lead Poisoning Prevention Program 2003
Risk factors for lead poisoning in Miami-Dade County
• Living in a home built prior to 1950
• Living in central urban area
• Low socio-economic status
• Living in a recently remodeled home
• Sibling or playmate with lead poisoning
• Refugee status
Percent of Housing Units Built Before 1950 by ZipcodeMiami-Dade County
33178
3303533034
33187
33196
33031
33030
33032
33018
33033
33157
33156
33170
33177
3317633186
33185
33192
33166
33182
33054
33172
3314333193
331753315533165
33140
33147
33142
33014
33169
33126
3301533055
33138
33161
33056
33012
33122
33183 33173
33139
33179
3316233160
33149
33189
33141
33134
33137
33016
33039
33167
33181
33013
33194
33133
33010
33125
33158
33150
33168
33190
33180
33146
33127
33154
33184 331443317433145
33132
33135
33136
33129
3313033128
3313133109
N
EW
S
% Housing Built Before 19500 - 2020 - 26>=27
33178
33018
3303433035
33030
33031
33187
33196
33032
33177
33186 33176
33192 33182
331753318533155
33143331733318333193
33156
33157
33039
3301533055 33056 33169
33179
33160
33180
33162
33161
33138
33140
33139
33149
33142
33147
3305433014
33012
33166
33122
33125
33134
33146
33133
33141
3315433168
33150
33127 33137
33194 33184 33174 33144
33126
33181
33135
33145
331 30
331 36
331 32
331 29
331 31
33189
3319033170
331 28
33165
33172
33013
33033
33158
331 09
33010
33167
Reported Lead Poisoning Cases in Miami-Dade County 1995-1998
N
Lead Poisoning Cases 0-25 Cases26-60 Cases >60 Cases
Lead poisoning prevalence among children screened at the
Refugee Health Assessment Center*,July 1, 2001 to June 30, 2002
Total Positive 85
Total Screened 992
Prevalence
85/992 = 9%
Childhood Lead Poisoning Prevention Program
• Screening
• Surveillance
• Follow-up
• Public and professional education
• Primary prevention
• Evaluation
Relevance to students’ lives
• May live in neighborhoods with soil lead hazards and may have younger siblings at risk
• May become parents and will need to know about preventing lead poisoning in their own children
• May be exposed in workplace or during hobbies in future