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

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hil

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n F

irst

Scr

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20

40

60

80

100

Pe

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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

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0

0.5

1

1.5

2

2.5

3

3.5

Inci

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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