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Reduction of elevated blood lead levels in children in North Carolina and Vermont, 1996-1999.
Environ Health Perspect. 2008 Jul; 116(7):981-5.EH

Abstract

BACKGROUND

Few studies have examined factors related to the time required for children's blood lead levels (BLLs) > or = 10 microg/dL to decline to < 10 microg/dL.

OBJECTIVES

We used routinely collected surveillance data to determine the length of time and risk factors associated with reducing elevated BLLs in children below the level of concern of 10 microg/dL.

METHODS

From the North Carolina and Vermont state surveillance databases, we identified a retrospective cohort of 996 children < 6 years of age whose first two blood lead tests produced levels > or = 10 microg/dL during 1996-1999. Data were stratified into five categories of qualifying BLLs and analyzed using Cox regression. Survival curves were used to describe the time until BLLs declined below the level of concern. We compared three different analytic methods to account for children lost to follow-up.

RESULTS

On average, it required slightly more than 1 year (382 days) for a child's BLL to decline to < 10 microg/dL, with the highest BLLs taking even longer. The BLLs of black children [hazard ratio (HR) = 0.84; 95% confidence interval (CI), 0.71-0.99], males (HR(male) = 0.83; 95% CI, 0.71-0.98), and children from rural areas (HR(rural) = 0.83; 95% CI, 0.70-0.97) took longer to fall below 10 microg/dL than those of other children, after controlling for qualifying BLL and other covariates. Sensitivity analysis demonstrated that including censored children estimated a longer time for BLL reduction than when using linear interpolation or when excluding censored children.

CONCLUSION

Children with high confirmatory BLLs, black children, males, and children from rural areas may need additional attention during case management to expedite their BLL reduction time to < 10 microg/dL. Analytic methods that do not account for loss to follow-up may underestimate the time it takes for BLLs to fall below the recommended target level.

Authors+Show Affiliations

Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Emergency and Environmental Health Services, Lead Poisoning Prevention Branch, Atlanta, GA 30341, USA. tdignam@cdc.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18629325

Citation

Dignam, Timothy A., et al. "Reduction of Elevated Blood Lead Levels in Children in North Carolina and Vermont, 1996-1999." Environmental Health Perspectives, vol. 116, no. 7, 2008, pp. 981-5.
Dignam TA, Lojo J, Meyer PA, et al. Reduction of elevated blood lead levels in children in North Carolina and Vermont, 1996-1999. Environ Health Perspect. 2008;116(7):981-5.
Dignam, T. A., Lojo, J., Meyer, P. A., Norman, E., Sayre, A., & Flanders, W. D. (2008). Reduction of elevated blood lead levels in children in North Carolina and Vermont, 1996-1999. Environmental Health Perspectives, 116(7), 981-5. https://doi.org/10.1289/ehp.10548
Dignam TA, et al. Reduction of Elevated Blood Lead Levels in Children in North Carolina and Vermont, 1996-1999. Environ Health Perspect. 2008;116(7):981-5. PubMed PMID: 18629325.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reduction of elevated blood lead levels in children in North Carolina and Vermont, 1996-1999. AU - Dignam,Timothy A, AU - Lojo,Jose, AU - Meyer,Pamela A, AU - Norman,Ed, AU - Sayre,Amy, AU - Flanders,W Dana, PY - 2007/06/11/received PY - 2008/03/05/accepted PY - 2008/7/17/pubmed PY - 2008/9/16/medline PY - 2008/7/17/entrez KW - blood lead level KW - capillary KW - chelation KW - children KW - surveillance KW - venous SP - 981 EP - 5 JF - Environmental health perspectives JO - Environ Health Perspect VL - 116 IS - 7 N2 - BACKGROUND: Few studies have examined factors related to the time required for children's blood lead levels (BLLs) > or = 10 microg/dL to decline to < 10 microg/dL. OBJECTIVES: We used routinely collected surveillance data to determine the length of time and risk factors associated with reducing elevated BLLs in children below the level of concern of 10 microg/dL. METHODS: From the North Carolina and Vermont state surveillance databases, we identified a retrospective cohort of 996 children < 6 years of age whose first two blood lead tests produced levels > or = 10 microg/dL during 1996-1999. Data were stratified into five categories of qualifying BLLs and analyzed using Cox regression. Survival curves were used to describe the time until BLLs declined below the level of concern. We compared three different analytic methods to account for children lost to follow-up. RESULTS: On average, it required slightly more than 1 year (382 days) for a child's BLL to decline to < 10 microg/dL, with the highest BLLs taking even longer. The BLLs of black children [hazard ratio (HR) = 0.84; 95% confidence interval (CI), 0.71-0.99], males (HR(male) = 0.83; 95% CI, 0.71-0.98), and children from rural areas (HR(rural) = 0.83; 95% CI, 0.70-0.97) took longer to fall below 10 microg/dL than those of other children, after controlling for qualifying BLL and other covariates. Sensitivity analysis demonstrated that including censored children estimated a longer time for BLL reduction than when using linear interpolation or when excluding censored children. CONCLUSION: Children with high confirmatory BLLs, black children, males, and children from rural areas may need additional attention during case management to expedite their BLL reduction time to < 10 microg/dL. Analytic methods that do not account for loss to follow-up may underestimate the time it takes for BLLs to fall below the recommended target level. SN - 0091-6765 UR - https://www.unboundmedicine.com/medline/citation/18629325/Reduction_of_elevated_blood_lead_levels_in_children_in_North_Carolina_and_Vermont_1996_1999_ L2 - https://ehp.niehs.nih.gov/doi/10.1289/ehp.10548?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -