Original article
Screening for Lead Poisoning: A Geospatial Approach to Determine Testing of Children in At-Risk Neighborhoods

https://doi.org/10.1016/j.jpeds.2008.09.027Get rights and content

Objective

To develop a spatial strategy to assess neighborhood risk for lead exposure and neighborhood-level blood lead testing of young children living in the city of Atlanta, Georgia.

Study design

This ecologic study used existing blood lead results of children aged ≤36 months tested and living in one of Atlanta's 236 neighborhoods in 2005. Geographic information systems used Census, land parcel, and neighborhood spatial data to create a neighborhood priority testing index on the basis of proxies for poverty (Special Supplemental Nutrition Program for Women, Infants and Children [WIC] enrollment) and lead in house paint (year housing built).

Results

In 2005, only 11.9% of Atlanta's 18 627 children aged ≤36 months living in the city had blood lead tests, despite a high prevalence of risk factors: 75 286 (89.6%) residential properties were built before 1978, and 44% of children were enrolled in WIC. Linear regression analysis indicated testing was significantly associated with WIC status (P < .001) but not with old housing.

Conclusions

This neighborhood spatial approach provided smaller geographic areas to assign risk and assess testing in a city that has a high prevalence of risk factors for lead exposure. Testing may be improved by collaboration between pediatricians and public health practitioners.

Section snippets

Methods

This study focused on the city of Atlanta. To define neighborhood level categories of risk of lead exposure and to evaluate the extent of childhood blood lead testing in neighborhoods with varying levels of risk, the study integrated the following data: (1) childhood blood lead testing data, (2) residential land parcel data, (3) 2000 U.S. Census data within a geographic information system (GIS), and (4) neighborhood spatial data from the Georgia Department of Community Affairs.

Neighborhood Risk

The city of Atlanta has 236 neighborhoods (median area: 0.29 square miles; range: 0.02-4.36 square miles) containing 87 791 properties, of which 95.7% were residential. Of the residential properties, 75 286 (89.6%) were pre-1978 and 47 142 (56.1%) were pre-1950. The median number of housing units built before 1950 per neighborhood is 47 (range, 0-2124). The median number of housing units built before 1978 per neighborhood is 163 (range, 0-2480). There were 18 627 children aged ≤36 months living

Discussion

This neighborhood spatial approach provided smaller geographic areas to assign risk and assess testing in a city that has a high prevalence of risk factors for lead exposure. Categorizing risk for lead poisoning is important, both for clinicians to determine which child to test and for public health practitioners to assess the extent to which children at high risk are being tested—and being tested in compliance with testing guidelines and laws—and to target lead poisoning prevention resources.

References (42)

  • B.P. Lanphear et al.

    Low-level environmental lead exposure and children's intellectual function: an international pooled analysis

    Environ Health Perspect

    (2005)
  • M.M. Tellez-Rojo et al.

    , Longitudinal associations between blood lead concentrations lower than 10 microg/dL and neurobehavioral development in environmentally exposed children in Mexico City

    Pediatrics

    (2006)
  • Preventing lead poisoning in young children: a statement from the Centers for Disease Control and Prevention. Atlanta: CDC; 2005 [cited 2006 Oct 20]

  • Increased lead absorption and lead poisoning in young children: a statement by the Center for Disease Control. Atlanta: US Department of Health, Education, and Welfare, CDC; 1975 [cited 2006 Oct 20]

  • Preventing lead poisoning in young children: a statement by the Centers for Disease Control, DHHS publication no. (CDC) 99-2230. Atlanta: US Department of Health and Human Services, CDC; 1985 [cited 2006 Oct 20]

  • Preventing lead poisoning in young children: a statement by the Centers for Disease Control - October 1991. Atlanta: US Department of Health and Human Services, Public Health Service, CDC; 1991 [cited 2006 Oct 20]

  • Screening young children for lead poisoning: guidance for state and local public health officials. Atlanta: US Department of Health and Human Services, Public Health Service, CDC; 1997 [cited 2006 Oct 20]

  • J.L. Pirkle et al.

    Exposure of the U.S. population to lead, 1991-1994

    Environ Health Perspect

    (1998)
  • R.B. Kaufmann et al.

    Elevated blood lead levels and blood lead screening among US children aged one to five years: 1988--1994

    Pediatrics

    (2000)
  • Blood lead levels—United States, 1999—2002. MMWR 2005 [cited 2006 Oct 20]; 54(20); 513-516

  • Ban of Lead-Containing Paint and Certain Consumer Products Bearing Lead-Containing Paint. 16 CFR 1303

    Fed Reg

    (1977)
  • Cited by (0)

    The authors declare no conflicts of interest, real or perceived. The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

    View full text