Analysis of disease profile, and medical burden by lead exposure from hospital information systems in China.

BACKGROUND: Though lead (Pb)-gasoline has been banned for decades in China, Pb continues to be a vital risk factor for various diseases. Traditional studies, without large sample size, were unable to identify explicitly the associations among Pb, its disease profile, and the related medical burden. This study was designed to investigate: 1) current status of blood Pb levels; 2) Pb-associated disease profile, medical burden, as well as impact factors. METHODS: Research subjects were patients who visited military hospitals and were required to test their blood Pb levels by doctors between 2013 and 2017. The large sample size and area coverage may, to a large extent, reveal the characteristics of Pb exposure in the whole Chinese population. Information of patients' electronic medical records was extracted using Structured Query Language (SQL) in Oracle database. The spatial, temporal, and population distribution of their blood Pb levels were tested, to illustrate the association of Pb exposure with diseases' profile, and medical burden. Non-parametric tests were applied to compare the differences of Pb levels among various groups. RESULTS: The blood Pb concentration showed a positively skewed distribution by Kolmogorov-Smirnov test (D = 0.147, p < 0.01). The blood Pb concentration of Chinese patients was 28.36 µg/L, with the lowest blood Pb levels, 4.71 µg/L, found in patients from Guangxi Zhuang Autonomous Region, and the highest, 50 µg/L, in Yunnan province. Han Chinese patients' Pb levels were significantly lower than other minorities groups (z-score = - 38.54, p < 0.01). Average medical cost for Pb poisoning was about 6888 CNY for Chinese patients. Pb levels of patients with malignant neoplasm of lung, 45.34 µg/L, were far higher than malignant neoplasm of other respiratory, and intrathoracic organs, 24.00 µg/L (z-score = - 2.79, p < 0.01). CONCLUSIONS: This study reported current status of blood Pb levels for patients who once visited military hospitals, partially representing the whole Chinese population. The result shows that Pb poisoning is still imposing marked economic burdens on patients under Pb exposure. Association of Pb with lung cancer may open up new areas for Pb-induced toxicology. The research strategy may advance toxicological studies in the aspect of medical data mining.

Lead in Spices, Herbal Remedies, and Ceremonial Powders Sampled from Home Investigations for Children with Elevated Blood Lead Levels - North Carolina, 2011-2018.

The number of pediatric cases of elevated blood lead levels (BLLs) are decreasing in North Carolina. However, one county reported an increase in the number of children with confirmed BLLs ≥5 µg/dL (CDC reference value, https://www.cdc.gov/nceh/lead/acclpp/blood_lead_levels.htm), from 27 in 2013 to 44 in 2017. Many children with elevated BLLs in this county lived in new housing, but samples of spices, herbal remedies, and ceremonial powders from their homes contained high levels of lead. Children with chronic lead exposure might suffer developmental delays and behavioral problems (https://www.cdc.gov/nceh/lead/). In 1978, lead was banned from house paint in the United States (1); however, children might consume spices and herbal remedies daily. To describe the problem of lead in spices, herbal remedies, and ceremonial powders, the North Carolina Childhood Lead Poisoning Prevention Program (NCCLPPP) retrospectively examined properties where spices, herbal remedies, and ceremonial powders were sampled that were investigated during January 2011-January 2018, in response to confirmed elevated BLLs among children. NCCLPPP identified 59 properties (6.0% of all 983 properties where home lead investigations had been conducted) that were investigated in response to elevated BLLs in 61 children. More than one fourth (28.8%) of the spices, herbal remedies, and ceremonial powders sampled from these homes contained ≥1 mg/kg lead. NCCLPPP developed a survey to measure child-specific consumption of these products and record product details for reporting to the Food and Drug Administration (FDA). Lead contamination of spices, herbal remedies, and ceremonial powders might represent an important route of childhood lead exposure, highlighting the need to increase product safety. Setting a national maximum allowable limit for lead in spices and herbal remedies might further reduce the risk for lead exposure from these substances.

From Lead Exposure in Early Childhood to Adolescent Health: A Chicago Birth Cohort.

OBJECTIVES: To assess the relationships between childhood lead exposure and 3 domains of later adolescent health: mental, physical, and behavioral. METHODS: We followed a random sample of birth cohort members from the Project on Human Development in Chicago Neighborhoods, recruited in 1995 to 1997, to age 17 years and matched to childhood blood test results from the Department of Public Health. We used ordinary least squares regression, coarsened exact matching, and instrumental variables to assess the relationship between average blood lead levels in childhood and impulsivity, anxiety or depression, and body mass index in adolescence. All models adjusted for relevant individual, household, and neighborhood characteristics. RESULTS: After adjustment, a 1 microgram per deciliter increase in average childhood blood lead level significantly predicts 0.06 (95% confidence interval [CI] = 0.01, 0.12) and 0.09 (95% CI = 0.03, 0.16) SD increases and a 0.37 (95% CI = 0.11, 0.64) point increase in adolescent impulsivity, anxiety or depression, and body mass index, respectively, following ordinary least squares regression. Results following matching and instrumental variable strategies are very similar. CONCLUSIONS: Childhood lead exposure undermines adolescent well-being, with implications for the persistence of racial and class inequalities, considering structural patterns of initial exposure.

Blood lead levels in children aged 1-5 years - United States, 1999-2010.

The adverse health effects of lead exposure in children are well described and include intellectual and behavioral deficits, making lead exposure an important public health problem. No safe blood lead level (BLL) in children has been identified. To estimate the number of children aged 1-5 years in the United States at risk for adverse health effects from lead exposure and to assess the impact of prevention efforts, CDC analyzed data from the National Health and Nutrition Examination Survey (NHANES) from the periods 1999-2002 to 2007-2010. This report summarizes the results of that analysis, which indicated that the percentage of children aged 1-5 years with BLLs at or above the upper reference interval value of 5 µg/dL calculated using the 2007-2010 NHANES cycle was 2.6%. Thus, an estimated 535,000 U.S. children aged 1-5 years had BLLs ≥5 µg/dL based on the U.S. Census Bureau 2010 count of the number of children in this age group. Despite progress in reducing BLLs among children in this age group overall, differences between the mean BLLs of different racial/ethnic and income groups persist, and work remains to be done to reach the Healthy People 2020 objective of reducing mean BLLs for all children in the United States (EH-8.2).

Blood lead level analysis among refugee children resettled in New Hampshire and Rhode Island.

OBJECTIVE: To examine the association between refugee status and elevated blood lead levels (EBLLs) among children living in two U.S. cities and to assess the effect of the Centers for Disease Control and Prevention recommendations for BLL testing of newly emigrated refugee children for EBLLs. DESIGN AND SAMPLE: A longitudinal study was conducted of 1,007 refugee children and 953 nonrefugee children living, when blood testing occurred, in the same buildings in Manchester, New Hampshire and Providence, Rhode Island. MEASURES: Surveillance and blood lead data were collected from both sites, including demographic information, BLLs, sample type, refugee status, and age of housing. RESULTS: Refugee children living in Manchester were statistically significantly more likely to have an EBLL compared with nonrefugee children even after controlling for potential confounders. We did not find this association in Providence. Compared with before enactment, the mean time of refugee children to fall below 10 µg/dL was significantly shorter after the recommendations to test newly emigrated children were enacted. CONCLUSIONS: Refugee children living in Manchester were significantly more likely to have an EBLL compared with nonrefugee children. And among refugee children, we found a statistically significant difference in the mean days to BLL decline <10 µg/dL before and after recommendations to test newly emigrated children.

Sources and risk factors for lead exposure in indigenous children of the Peruvian Amazon, disentangling connections with oil activity.

INTRODUCTION: In the Corrientes river basin, Peruvian Amazon, lead exposure among indigenous communities was first reported in 2006. To address controversy regarding the main source of exposure, this study aimed to identify the sources and risk factors for lead exposure among children from the communities in question, and to clarify the potential relationship with oil activity. METHODS: This cross-sectional study was conducted in six communities. Participants were children aged 0-17 years and their mothers. Data collection included blood lead levels (BLLs) and hemoglobin determination, a questionnaire on risk factors and environmental sampling. We used age-stratified multivariate regression models, with generalized estimating equation to account for correlation within households. RESULTS: Twenty-seven percent of the children had BLLs ≥10 µg/dl. Mother's BLLs ≥10 µg/dl, playing and chewing lead scraps, fishing ≥three times/week, and living in highly oil-exposed communities increased the risk of having BLLs ≥10 µg/dl. Lead concentrations in sediment, soil, dust, and fish samples were below reference values. CONCLUSIONS: Mother's BLLs ≥10 µg/dl, playing and chewing lead scraps to manufacture fishing sinkers were the most important risk factors for children's BLLs ≥10 µg/dl. The connection with oil activity appears to be through access to metal lead from the industry's wastes.

Blood lead levels of refugee children resettled in Massachusetts, 2000 to 2007.

OBJECTIVES: We described elevated blood lead level (BLL; ≥ 10 µg/dL) prevalence among newly arrived refugee children in Massachusetts. We also investigated the incidence of BLL increases and BLLs newly elevated to 20 µg/dL or higher in the year following initial testing, along with associated factors. METHODS: We merged data from the Massachusetts Department of Public Health's Refugee and Immigrant Health Program and the Childhood Lead Poisoning Prevention Program on 1148 refugee children younger than 7 years who arrived in Massachusetts from 2000 to 2007. RESULTS: Elevated BLL prevalence was 16% among newly arrived refugee children. The rate ratio for BLL elevation to 20 µg/dL or higher after arrival was 12.3 (95% confidence interval [CI] = 6.2, 24.5) compared with children in communities the state defines as high-risk for childhood lead exposure. Residence in a census tract with older housing (median year built before 1950) was associated with a higher rate of BLL increases after resettlement (hazard ratio = 1.7; 95% CI = 1.2, 2.3). CONCLUSIONS: Refugee children are at high risk of lead exposure before and after resettlement in Massachusetts. A national surveillance system of refugee children's BLLs following resettlement would allow more in-depth analysis.

Lead poisoning among internally displaced Roma, Ashkali and Egyptian children in the United Nations-Administered Province of Kosovo.

BACKGROUND: This study assessed the association between lead poisoning prevention activities and blood lead levels (BLLs) among children living in lead-contaminated camps for internally displaced persons in the United Nations-Administered Province of Kosovo. METHODS: We conducted a population-based study to examine the relationship among geometric mean BLLs in children (i) born before any lead poisoning prevention activities were instituted, (ii) born when specific interim interventions were instituted and (iii) born after relocation and medical therapy were available. The study population consisted of 145 of the 186 children born in the camps between December 1999 and July 2007. RESULTS: Lower mean BLLs were found in children born following implementation of the interventions as compared with the children born before the interventions. However, this decrease in mean BLLs was attenuated in children born into families suspected of informal lead smelting. CONCLUSION: Despite lower BLLs following interventions, children living in these camps have BLLs that remain unacceptably high. Further efforts are urgently needed to control or eliminate lead exposure in this population. Continued blood lead monitoring of the population is also warranted.

Blood Lead Levels Among Resettled Refugee Children in Select US States, 2010-2014.

BACKGROUND: Elevated blood lead levels (EBLLs; ≥5 µg/dL) are more prevalent among refugee children resettled in the United States than the general US population and contribute to permanent health and neurodevelopmental problems. The Centers for Disease Control and Prevention recommends screening of refugee children aged 6 months to 16 years on arrival in the United States and retesting those aged 6 months to 6 years between 3- and 6-months postarrival. METHODS: We analyzed EBLL prevalence among refugee children aged 6 months to 16 years who received a domestic refugee medical examination between January 1, 2010 and September 30, 2014. We assessed EBLL prevalence by predeparture examination country and, among children rescreened 3 to 6 months after initial testing, we assessed EBLL changes during follow-up screening. RESULTS: Twelve sites provided data on 27 284 children representing nearly 25% of refugee children resettling during the time period of this analysis. The EBLL prevalence during initial testing was 19.3%. EBLL was associated with younger age, male sex, and overseas examination country. Among 1121 children from 5 sites with available follow-up test results, EBLL prevalence was 22.7%; higher follow-up BLLs were associated with younger age and predeparture examination country. CONCLUSIONS: EBLL decreased over the time period of our analysis in this population of refugee children. Refugee children may be exposed to lead before and after resettlement to the United States. Efforts to identify incoming refugee populations at high risk for EBLL can inform prevention efforts both domestically and overseas.

Implementation of CDC refugee blood lead testing guidelines in Minnesota.

The state of Minnesota undertook a trial of the 2005 recommendations for blood lead testing in refugees developed by the Centers for Disease Control and Prevention. New refugee children younger than 16 years of age receiving health screening at an urban clinic were tested for elevated blood lead levels (EBLLs) and nutritional status. Follow-up lead tests were obtained three to six months after the first test. During the course of the project, 150 refugee children received an initial blood lead test and nutritional blood tests, and 140 (93%) received a second blood lead test. Five children (3.3%) had EBLLs at the initial blood lead test and one child (0.7%) had an EBLL at the second test after a nonelevated first test result. In contrast to findings from New Hampshire, this project did not observe a high number of refugees who developed EBLLs after moving to the U.S.

Lack of association of delta-aminolevulinic acid dehydratase genotype with blood lead levels in environmentally exposed children of Uygur and Han populations.

AIM: A cross-section study was conducted to explore the association between polymorphism of delta-aminolevulinic acid dehydratase (ALAD) and lead poisoning in Uygur and Han children in China. METHODS: The ALAD genotyping was determined by PCR-RFLP in 443 Uygur and 469 Han children aged 6-10 years from Urumqi in Xinjiang province. RESULTS: The blood lead levels of 912 environmentally exposed children ranged from 0.5 to 48.2 microg/dL, with a mean of 5.45 microg/dL and a standard deviation of 0.22 microg/dL, and 23. Thirty-one percent individuals were with blood lead level > or =10 microg/dL. The mean and standard deviation of blood lead levels were 5.57 +/- 0.223 microg/dL and 5.30 +/- 0.224 microg/dL in Uygur and Han children, respectively. The frequencies of the allele ALAD1 and ALAD2 in Uygur subjects were 90.52% and 9.48%, and in Han subjects were 95.73% and 4.27%, respectively (chi-square = 19.55, p < 0.05). No statistic correlation between the distribution of ALAD alleles and the blood lead level was found in both populations. CONCLUSION: A significant difference was seen in the frequency distribution of ALAD genotype between the different races. The genetic susceptibility of ALAD polymorphism to lead toxicity may exhibit in a lead dose-dependent manner.

"The horizon opened up very greatly": Leland O. Howard and the transition to chemical insecticides in the United States, 1894-1927.

The transition to synthetic chemicals as a popular method of insect control in the United States was one of the most critical developments in the history of American agriculture. Historians of agriculture have effectively identified the rise and charted the dominance of early chemical insecticides as they came to define commercial agriculture between the emergence of Paris green in the 1870s and the popularity of DDT in the 1940s and beyond. Less understood, however, are the underlying mechanics of this transition. this article thus takes up the basic question of how farmers and entomologists who were once dedicated to an impressively wide range of insect control options ultimately settled on the promise of a chemically driven approach to managing destructive insects. Central to this investigation is an emphasis on the bureaucratic maneuverings of Leland O. Howard, who headed the Bureau of Entomology from 1894 to 1927. Like most entomologists of his era, Howard was theoretically interested in pursuing a wide variety of control methods--biological, chemical, and cultural included. In the end, however, he employed several tactics to streamline the government's efforts to almost exclusively support arsenic and lead-based chemical insecticides as the most commercially viable form of insect control. While Howard in no way "caused" the national turn to chemicals, this article charts the pivotal role he played in fostering that outcome.

Elevated lead level from a tobacco source requiring chelation in a 12-year-old child.

CONTEXT: Across the world, tobacco is used in a variety of forms, including being smoked or added to a "quid" that is then chewed. We report a case of lead poisoning in a child from tobacco imported from Thailand. CASE DETAILS: A 12-year-old Thai immigrant boy had a blood lead level (BLL) of 6 mcg/dL on routine testing upon arrival to the United States, but which increased to 72 mcg/dL six months after his arrival. He was asymptomatic with unremarkable workup. At this time his father, mother and two siblings were also found to have elevated BLLs of 53, 16, 22, and 11 mcg/dL, respectively. Water, paint, food and cookware sources tested negative for lead, whereas samples of the father's dried tobacco leaves imported from Thailand contained 36.12 ppm (mcg/g) of lead. The mother admitted that both she and the patient used the tobacco as well. The child was chelated with oral succimer and his BLL decreased. DISCUSSION: In our case, the source of the lead exposure was from the tobacco that the patient was chewing. Tobacco is often overlooked as a source of lead exposure, though it has been reported in the literature, both from direct smoking and from chewing, as well as through secondhand smoke. Toxicologists and health care professionals should consider cultural practices when evaluating patients with elevated BLLs.

Exposure to lead and length of time needed to make homes lead-safe for young children.

OBJECTIVES: We determined the length of time needed to make homes lead-safe in a population of children aged 0 to 6 years with blood lead levels (BLLs) of 20 micrograms per deciliter (mug/dL) or greater. Reducing this time would reduce children's exposure to lead. METHODS: Data came from the Wisconsin Childhood Lead Poisoning Prevention Program's comprehensive blood lead surveillance system. Analysis was restricted to children whose first BLL test value during 1996-1999 was between 20 and 40 mug/dL and for whom housing intervention data were available (n=382). RESULTS: The median length of time required to make a home lead-safe was 465 days. Only 18% of children lived in homes that were made lead-safe within 6 months; 45% lived in homes requiring more than 18 months to be lead-safe. CONCLUSIONS: Efforts are needed to reduce the time it takes to make a home lead-safe. Although abatement orders always include time limits, improved compliance with the orders must be enforced. Greater emphasis should be placed on securing lead-safe or lead-free housing for families, thus reducing lead exposure.

The environmental health of Latino children.

Representing 1 in 6 children in the United States, Latino children incur disproportionate exposures to air pollutants, pesticides, and toxic industrial chemicals, as well as lead and mercury from candy, traditional folk remedies, religious practices, and other sources. Latino children also have higher rates of asthma, lead and mercury poisoning, behavioral and developmental disorders, and certain cancers. Concurrent exposure to multiple pollutants, pre-existing disease, poor nutrition, substandard housing, limited access to health care, and other factors related to their lower socioeconomic status increase Latino children's susceptibility to environmental contaminants. Targeted research, education, prevention and intervention efforts, and economic development initiatives are needed.

Yemeni families and child lead screening in Detroit.

This project was an exploratory effort to screen and treat immigrant Yemeni children who were at high risk for lead poisoning. The Detroit metropolitan area is home to the largest number of Arabic immigrants in the United States. In addition, Detroit has the largest rate of childhood lead poisoning in the state of Michigan. No published studies were found that explored the prevalence of lead poisoning among Yemeni children in Michigan. Immigrant children from countries where knowledge of lead poisoning is limited may be particularly vulnerable because of difficulties in language and accessing health care. Children's Hospital of Michigan CATCH School Mobile Health Center conducted this health-screening project. This article reports on the gender and health issues encountered during the community outreach lead testing effort within a Yemeni neighborhood in Detroit.

Is tetraethyl lead poison affecting contemporary indigenous suicides in Ontario, Canada?

Prior to the mid-1980s, suicide in Indigenous population in Northwestern Ontario, Canada, was rare, occurring at rates of 1-2 per year among over 20 communities. By the early 1990s, the completed suicide rates in the same communities were among the highest in the world. Prior to the outbreak of the suicide epidemic, sniffing of gasoline containing tetraethyl was common in many communities. Existing literature confirms that tetraethyl lead poisoning is associated with alterations to the amyloid-ß protein precursor and amyloid-ß as well as the 5-HT-1B receptor. The presence of this risk factor within the population warrants further inquiry.

Binational study of pediatric blood lead levels along the United States/Mexico border.

To evaluate lead exposure among children living in border communities, the states of Arizona and New Mexico in the United States (US), and the states of Sonora and Chihuahua in Mexico collaboratively requested that the Centers for Disease Control and Prevention (CDC) provide technical assistance to document pediatric blood lead levels (BLLs) in children living along this part of the US/Mexico border. Two studies were conducted to evaluate BLLs of children aged 1-6 years. In 1998, 1210 children were tested in the Arizona/Sonora study; in 1999, 874 children were tested in New Mexico/Chihuahua. Overall geometric mean BLL was 32.5 microg/l (95% Confidence Interval 31.5-33.5) with BLLs ranging from below limit of detection to 320.0 microg/l. Mean BLLs were higher among children living on the Mexican side of the border (43.2 microg/l) compared to those on the US side (22.3 microg/l). Mean BLLs ranged from 14.9 to 31.2 microg/l at the US sites and from 26.9 to 55.2 microg/l at the Mexican sites. This study used a convenience sample and cannot be considered representative of the general population. Nonetheless, the range of mean BLLs among the sites and especially the higher mean BLLs among children living in the border communities in Mexico suggests different exposures to lead and warrants further attention.