Childhood Lead Poisoning in New York State

1
Childhood Lead Poisoning in New York State

• Symposium To Examine Lead Poisoning in NYS
• March 13, 2006
• Rachel de Long, M.D., M.P.H.
• Director, Bureau of Child and Adolescent Health
• NYS Department of Health

2
Childhood Lead Poisoning A preventable public
health problem

• Lead poisoning defined as a blood lead level gt 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

3
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

4
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

5
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

6
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)

7
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

8
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
9
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
10
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

11
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

12
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)

13
(No Transcript)
14
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

15
(No Transcript)
16
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 gt20 473 422
Incident rate gt20 No rate available 0.2/100 tests 23 decrease since 2000
NYC rates are based on tests of children 0-18
years of age
17
(No Transcript)
18
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 gt5 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 (gt15mcg/dL) in NYC
• Brooklyn has 10 of 11 neighborhoods with EIBLL
  rates higher than the citywide incidence rate.

19
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.
20
Lead Poisoning distribution in NYS, by county,
1999-2001
21
High Incidence rate Zip Codes, 2001
22
High-incidence rates in NYC, 2003
23
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

24
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

25
Questions and Discussion