CDC, NIOSH’s Adult Blood Lead Epidemiology and Surveillance (ABLES) Program[Robert Roscoe, rroscoe@cdc.gov, 513-841-4424]

NIOSH--State partnership to prevent elevated BLLs in adults

• By state-based tracking of laboratory-reported BLLs

• By encouraging intervention research and practice

Surveillance case definition for an adult elevated BLL is 25 g/dL or greater

• ABLES public health goal in Healthy People 2010 is to reduce the rate of adults who have

blood lead levels of 25 g/dL or greater to zero by 2010

OSHA currently

• Allows adults to return to work when their BLL falls below 40 mcg/dL

• But has National Emphasis Program to reduce lead levels

Disclaimer: The findings and conclusions in this presentation have not been formally disseminated by the National Institute for Occupational Safety and Health and should not be construed to represent any agency determination or policy.

TM

What does the national ABLES program do?

Fund and process data collection--37 sole-source contracts

• $22,120 ($21,440) per state, $805,200 for FY2006 (partial $18,800)

• Data management & validity

• Technical assistance and collaboration

• Medical

• Industrial hygiene

• Epidemiologic

• Communications

• Web topic page: www.cdc.gov/niosh/topics/ABLES/ables.html

• National meeting (with CSTE)

• Listserv, MMWR and other publication TM

Strategic accomplishments from ABLES Program in FY06

Make ABLES data more useful to outsiders

• Publish 2003-2004 ABLES report in MMWR (Roscoe, Graydon)

• posting of 1994-2004 summary data on ABLES topic page (Graydon, Roscoe)

• OSHA--MOU to share ABLES (and IMIS) data (Roscoe, Boiano, SHEFS)

• NCEH—offer to Lead in Pregnancy Workgroup (Whelan, Roscoe)

Make ABLES data more useful to NIOSH and as NORA surveillance tool

• Construction sector--FY07 NORA proposal (Roscoe, Piacitelli, Boiano)

• Manufacturing & Mining sectors—offer of FY08 NORA collaboration (Roscoe)

TM

What research does the national ABLES program take part in?

Research collaborations/partnerships

• Epidemiologic study led by Steenland of cancer (lung, stomach, brain, kidney), stroke,

diabetes & non-malignant kidney disease

• AOEC Clinical BLL Guidelines

• NCEH NEDSS partnership for standardized surveillance

• NCEH Lead and Pregnancy workgroup

• NCEH Federal task force on nonresidential environmental lead sources

• Federal Lead-based paint task force

TM

States reporting to ABLES in 2007 (37)

ABLES states

with contracts

TM

National prevalence rate for adults with BLLs >25 g/dLbased on ABLES data reported 1994-2004

*Rate per 100,000 employed 16 and older

7.88.7

9.2

8.58.2

7.5

11.112.311.612.1

14.815

14.914

0

2

4

6

8

10

12

14

16

18

1994 (17) 1995 (18) 1996 (20) 1997 (24) 1998 (24) 1999 (25) 2000 (25) 2001 (23) 2002 (35) 2003 (37) 2004 (37)

Year (number of states reporting)

Residents plus nonresidents Residents only

*Bureau of Labor Statistics, Current Population SurveyTM

State prevalence rates for resident adults

with peak blood lead levels >25 g/dL, 2003 - 2004 averages

<10

10-19

>20

Not an

ABLES state

Annual rate per 100,000 employed*

*Bureau of Labor Statistics, Current Population Survey

TM

Percent residents with BLLs >25 g/dLby race, ethnicity age, sex, reported by ABLES states 2003-2004 average

n = 3278 (66% race missing)

American Indian/Alaskan

native1%

Asian1%

Other0%

Black21%

Hispanic or Latino13%White

64%

Sex

94% male

6% female

Age

1.6% 16-19 years

96% 20-64 years

2.4% 65 and older

TM

Percent of adults with blood lead levels >25 g/dLby industrial sector, reported by ABLES states, 2003 - 2004 average

Manufacturing 69%

Wholesale/Retail Trade

1%

Mining7%

Transportation warehousing &

Utilities 2%

Construction 19%

Healthcare & social assistance

0.07%

Agriculture, forestry & fishing0.03%

Services 2%

Lead sources: 94% occupational, 6% nonoccupational TM

Industries reporting greatest number of resident workers with elevated BLLs

reported by 32 of 37 ABLES states, 2003-2004 average

1. Manufacture of storage batteries [SIC 3691, NAICS 335911] 2499 147 ( 6%)2. Painting, paperhanging & decorating [SIC 1721, NAICS 238320] 626 156 (25%)3. Mining of lead ores [SIC 1031, NAICS 212231] 482 94 (20%)4. Secondary smelting [SIC 3341, NAICS 331492] 300 39 (13%)5. Bridge and tunnel construction [SIC 1622, NAICS 237310] 211 45 (21%)6. Manufacture of primary batteries [SIC 3692, NAICS 335912] 210 39 (19%)7. Primary smelting [SIC 3339, NAICS 331419] 200 26 (13%)8. Lead paint removal [SIC 1799, NAICS 562910] 160 40 (25%)9. Copper foundries [SIC 3366, NAICS 331525] 114 21 (18%)10. Roll & draw nonferrous metals [SIC 3356, NAICS 331491] 90 16 (18%)

Industry [Standard Industrial Classification (SIC), North American Industry Classification System (NAICS)]

Worker BLLs >25 g/dL

Worker BLLs >40 g/dL (%)

TM

Lead-exposed resident painters* with BLLs >=25 mcg/dLreported by 23** ABLES States in 2004, n = 742

0

10

20

30

40

50

60

25 27 29 31 33 35 37 39 41 43 45 47 49 51 -108

BLL (mcg/dL)

Number

* SIC 1799 and 1721, NAICS 562910 and 238320

** CA, CT, FL, HI, IL, MA, MD, ME, MI, MN, MO, NC, NH, NJ, NY, OH, OK, OR, PA, TX, UT, WA, WI

TM

How bad is under reporting—especially in the construction industry?

Only 23 ABLES states reported even one painter with a BLL >=25 mcg/dL (2004)

• AK, AZ, GA, IA, KS, MT, NE, NM, SC, WY reported no painters >= 25mcg/dL

• Could this be true?

• If not, were the painters not tested or were the tests not sent to state ABLES?

What can your state lead surveillance program do to make sure that appropriate

testing for painters (and other under reported industries) is being done and reported to

you?

Only 12 states reported painters with a BLL of <25 mcg/dL (2004)

• CA, FL, MA, ME, MN, MO, NH, NY, OK, PA, WI reported 1,325 painters tested <25/mcg/dL

• This lets National ABLES know that some tests on painters are being done.

TM

Estimates of national prevalence rate for adults with BLLs >25 g/dL projected to 2010 based on ABLES data reported 1994-2004

*Rate per 100,000 employed 16 and older

7.88.7

9.2

~8.0 ~7.5

~7.0 ~6.5~6.1 ~5.7

8.58.2

7.5

11.112.311.612.1

14.815

14.914

0

2

4

6

8

10

12

14

16

18

1994

(17)

1995

(18)

1996

(20)

1997

(24)

1998

(24)

1999

(25)

2000

(25)

2001

(23)

2002

(35)

2003

(37)

2004

(37)

2005 2006 2007 2008 2009 2010

Year (number of states reporting)

Residents plus nonresidents Residents only Projected rates for residents plus nonresidents (exponential) *Bureau of Labor Statistics, Current Population Survey

[---Estimated national rates to 2010----]

TM

ABLES proposed pilot intervention project for NIOSH’sNational Occupational Research Agenda (NORA) FY07

To lower BLLs in workers involved in lead-paint removal

• Renovation, remodeling, remediation, painting

By letting contract to have ABLES state or other entity develop and

carryout model intervention

• ~$47,000 per year for three years

• Evaluate intervention effectiveness

• Develop information products for transfer to other states

TM

Where is ABLES likely to go?

Grows ever-closer to NCEH’s childhood lead program

• Standardized data collection under NEDSS

• Greater efficiency for the states

• Joint childhood and adult lead surveillance clearance obtained from OMB in FY05

Possibly evolves into part of NIOSH’s Fundamental Program of Occupational

Surveillance as the lead indicator

• Back to extramural funding, COSS participation

Possibly becomes part of an over-arching CDC program for occupational,

environmental and injury surveillance

Disappears when competing NIOSH funding priorities become more important than

lead surveillance?

TM

States reporting to ABLES in 2007 (37)

ABLES states

with contracts

11 ABLES states

with contracts & new

Fundamental

Surveillance Programs

New FundamentalSurveillance Program,no ABLES contract

TM