Characteristics of US workers whose blood lead levels trigger the medical removal protection provision, and conformity with biological monitoring requirements, 2003-2005.

BACKGROUND: Workers with blood lead levels (BLL) > or =60 microg/dl (50 microg/dl for construction workers) or with three or more consecutive BLLs over at least 6 months that average 50 microg/dl or greater are required to be removed from work involving lead exposure that exceeds the OSHA action level. This study estimates the proportion of workers with BLLs that trigger the medical removal provision by industry sector, and examines whether workers received appropriate follow-up blood lead testing. METHODS: Three years (2003-2005) of data from the Adult Blood Lead Epidemiology and Surveillance program were analyzed to identify those industries with a high percentage of workers with BLLs that trigger the medical removal provision. Adjusted rate ratios (RR) of adults with such BLLs were estimated by industry sector compared to the battery manufacturing industry using Poisson regression models. RESULTS: Out of 13,724 adults with BLLs > or =25 microg/dl, a total of 533 adults had BLLs that triggered the medical removal provision. RRs of adults with BLLs triggering medical removal were highest for "painting and wall covering contractors" (RR = 22.1) followed by "highway, street and bridge construction" (RR = 14.7), "amusement, gambling, and recreation" (RR = 11.4), and "glass product manufacturing" (RR = 10.1). Overall, 29% of adults with BLLs triggering medical removal received appropriate follow-up blood lead tests and met the eligibility to return to lead work. CONCLUSIONS: These findings suggest that additional efforts are needed to prevent occupational overexposure to lead in adults, and to ensure proper medical management of those workers who meet medical removal criteria.

Adult blood lead epidemiology and surveillance--United States, 1998-2001.

PROBLEM/CONDITION: Elevated blood lead levels (BLLs) in adults can damage the cardiovascular, central nervous, reproductive, hematologic, and renal systems. The majority of cases are workplace-related. U.S. Department of Health and Human Services recommends that BLLs among all adults be reduced to < 25 microg/dL. The highest BLL acceptable by standards of the U.S. Occupational Safety and Health Administration is 40 microg/dL. The mean BLL of adults in the United States is < 3 microg/dL. REPORTING PERIOD: This report covers cases of adults (aged > or = 16 years) with BLLs > or = 25 microg/dL, as reported by 25 states during 1998-2001. DESCRIPTION OF SYSTEM: Since 1987, CDC has sponsored the state-based Adult Blood Lead Epidemiology and Surveillance (ABLES) program to track cases of elevated BLLs and provide intervention consultation and other assistance. Overall ABLES program data were last published in 1999 for the years 1994-1997. This report provides an update with data from 25 states reporting for > or = 2 years during 1998-2001. During that period, the ABLES program funded surveillance in 21 states - Alabama, Arizona, Connecticut, Iowa, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Washington, Wisconsin, and Wyoming. Four additional states - California, Nebraska, New Hampshire, and Utah contributed data without CDC funding. RESULTS: During 1998-2001, the overall program's annual mean state prevalence rate for adults with BLLs > or = 25 microg/dL was 13.4/100,000 employed adults. This compares with 15.2/100,000 for 1994-1997. Yearly rates were 13.8 (1998), 12.9 (1999), 14.3 (2000), and 12.5 (2001). For adults with BLLs > or = 40 microg/dL, the overall program's annual mean state prevalence rare during 1998-2001 was 2.9/ 100,000 employed adults. This compares with 3.9/100,000 for 1994-1997. Yearly rates were 3.3 (1998), 2.5 (1999), 2.9 (2000), and 2.8 (2001). INTERPRETATION: Although certain limitations exist, the overall ABLES data indicate a declining trend in elevated BLLs among employed adults. PUBLIC HEALTH ACTIONS: ABLES-funded states increased from 21 to 35 in 2002, and more detailed reporting requirements were put into effect. These, and other improvements, will enable the ABLES program to work more effectively toward its 2010 target of eliminating all cases of BLLs > or = 25 microg/dL in adults caused by workplace exposures.