Prevalence of elevated blood lead levels in an inner-city pediatric clinic population.

In November 1997, the Centers for Disease Control and Prevention (CDC) released revised guidelines for lead poisoning screening, including a recommendation that states and regions individualize screening policies based on local prevalence of elevated lead levels. The purpose of this study was to collect prevalence data for a Philadelphia, Pennsylvania, inner-city pediatric outpatient population previously not known to have elevated blood lead levels in order to determine its risk for lead exposure and screening requirements. Charts were reviewed for 817 children of 10 months through 6 years of age whose venous blood lead levels were obtained as part of their routine health care over a 12-month period ending October 1992. None of these children had a history of previously elevated lead levels. Prevalence of elevated lead levels was determined for this population and correlated with patient age, sex, race, and insurance type. More than two-thirds (68%) of the study patients had a blood lead level of [Greater than and equal to]10 microg/dl. Elevated blood lead levels were associated with black race (p<0.0001), but not with sex or insurance type. The percentage of children with elevated blood lead levels was highest at ages 37-48 months. A majority of the children screened had lead levels in excess of the CDC threshold for an abnormal lead level (10 microgram/dl). This is the highest reported prevalence within a U.S. pediatric clinic population. In view of this extremely high prevalence, clinicians and public health personnel caring for children in Philadelphia inner-city clinics must follow the intent of the new CDC guidelines by increasing their efforts in the areas of screening, follow-up, and environmental interventions. To ensure a lead-safe upbringing for children in the United States, state health officials nationwide should perform local risk assessments before considering policy transitions from universal to targeted screening.