Pediatric Blood Lead Level Testing Rates Among Populations with Risk Factors for Lead Exposure — Indiana, 2017

  • Maternal and child health
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Background:
Pediatric lead exposure can have detrimental effects on cognition and other health outcomes. Common risk factors for lead exposure include residence in older housing and lower socioeconomic status (SES). Blood lead level (BLL) screening is recommended for all children, with testing encouraged for those at risk, and testing required for those enrolled in Medicaid; results of all BLL tests are reportable in Indiana. We examined rates of pediatric BLL testing among populations with risk factors for lead exposure to guide public health outreach.

Methods:
The addresses of Indiana residents aged <7 years with ≥1 BLL test in 2017 were geocoded by census tract; BLL testing rates were calculated. Estimated proportions of the population residing in homes built pre-1940, and those aged <18 years enrolled in Medicaid (proxy for low SES) were obtained from the 2016 American Community Survey and mapped by census tract using Esri ArcGIS Desktop 10.5.1. Census tracts with higher proportions (>60%) of risk factors and lower (<50th percentile) pediatric BLL testing rates were identified.

Results:
In total, 65,297 children aged <7 years had ≥1 BLL test reported in 2017, with a median testing rate of 73 tests/1,000 population (range: 2–2100). Addresses of 49,434 (76%) children were geocoded. Among 1,511 census tracts, 240 (16%) had >60% of children enrolled in Medicaid and 80 (5%) had >60% of homes built pre-1940. Eight (0.53%) census tracts had higher proportions of both risk factors and lower BLL testing rates (range: 51–73/1,000 population). All were located in urban areas, including Indianapolis (3), Fort Wayne (2), Muncie (2), and Evansville (1).

Conclusion:
We identified areas with low pediatric BLL testing rates despite higher proportions of risk factors for lead exposure. Outreach to healthcare providers in these areas might help identify children with previously unrecognized need for medical treatment and environmental remediation to reduce future exposures.

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