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.

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.

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.

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.

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.

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.

Racial/Ethnic Differences in Childhood Blood Lead Levels Among Children <72 Months of Age in the United States: a Systematic Review of the Literature.

Childhood lead poisoning is a serious public health problem with long-term adverse effects. Healthy People 2020's environmental health objective aims to reduce childhood blood lead levels; however, efforts may be hindered by potential racial/ethnic differences. Recent recommendations have lowered the blood lead reference level. This review examined racial/ethnic differences in blood lead levels among children under 6 years of age. We completed a search of PubMed, CINAHL, and PsycINFO databases for published works from 2002 to 2012. We identified studies that reported blood lead levels and the race/ethnicity of at least two groups. Ten studies met inclusion criteria for the review. Blood lead levels were most frequently reported for black, white, and Hispanic children. Six studies examined levels between blacks, whites, and Hispanics and two between blacks and whites. Studies reporting mean lead levels among black, whites, and Hispanics found that blacks had the highest mean blood lead level. Additionally, studies reporting blood lead ranges found that black children were more likely to have elevated levels. Studies suggest that black children have higher blood lead levels compared to other racial/ethnic groups. Future studies are warranted to obtain ample sample sizes for several racial/ethnic groups to further examine differences in lead levels.

Disease, risk, and contagion: French colonial and postcolonial constructions of "African" bodies.

In this article, we explore how sub-Saharan African immigrant populations in France have been constructed as risk groups by media sources, in political rhetoric, and among medical professionals, drawing on constructs dating to the colonial period. We also examine how political and economic issues have been mirrored and advanced in media visibility and ask why particular populations and the diseases associated with them in the popular imagination have received more attention at certain historical moments. In the contemporary period we analyze how the bodies of West African women and men have become powerful metaphors in the politics of discrimination prevalent in France, in spite of Republican precepts that theoretically disavow cultural and social difference.

Investigation of delta-aminolevulinic acid dehydratase polymorphism affecting hematopoietic, hepatic and renal toxicity from lead in Han subjects of southwestern China.

UNLABELLED: This study is to explore the effect of ALAD polymorphism on hematopoietic, hepatic and renal toxicity from lead in occupational exposure workers. METHODS: We conducted a cross-sectional study on 156 workers with occupational exposure to lead between 2002 and 2007. The results of laboratory examinations were analyzed. RESULTS: The authors found that workers with the ALAD 1-1 genotype were associated with higher blood lead level than those with the ALADl-2 genotype. Blood and urine lead levels were much higher in storage battery workers than in cable workers. The urine ALA and blood ZPP levels in workers with the ALAD 1-1 genotype were higher than those with the ALADl-2 genotype. The serum Cr level in workers with the ALADl-1 genotype was much higher than those with the ALADl-2 genotype especially in higher lead exposure level. CONCLUSIONS: The ALAD-2 protein might modify the kinetics of lead in blood at a relatively higher blood lead level and protect against hematopoietic, hepatic and renal toxicity from lead. Urine ALA, blood ZPP and serum Cr levels might be considered as effective biological monitoring partners of lead induced hematopoietic and renal toxicology.

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).

Improving participation by Aboriginal children in blood lead screening services in Broken Hill, NSW.

UNLABELLED: Lead poses a health risk to young children with detrimental effects on their intellectual development. Attendance rates for Aboriginal children at routine blood lead screening and at follow-up appointments in Broken Hill, NSW, have declined in recent years. This study sought to identify strategies to improve the participation of Aboriginal children aged 1-4 years in blood lead screening services in Broken Hill. METHODS: Attendance rates during the period 2000-2010 were determined using the Broken Hill Lead Management database. From June to August 2011, Aboriginal community members, service providers and public health staff were invited to interviews and focus groups to explore barriers, enablers and suggestions for improving participation. RESULTS: In 2009, 27% of Aboriginal children aged 1-4 years attended blood lead screening and 29% of these children with blood lead levels over 15 µg/dL attended follow-up appointments. Barriers to participation in lead screening services included community perceptions, reduced service capacity, socio-economic and interorganisational factors. Enablers included using a culturally acceptable model, linking lead screening with routine health checks and using the finger-prick method of testing. CONCLUSIONS: The final report for the study included recommendations to improve participation rates of Aboriginal children including using social marketing, formalising collaboration between health services, supporting disadvantaged families and employing an Aboriginal Health Worker.

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.

Lead poisoning in United States-bound refugee children: Thailand-Burma border, 2009.

BACKGROUND: Elevated blood lead levels lead to permanent neurocognitive sequelae in children. Resettled refugee children in the United States are considered at high risk for elevated blood lead levels, but the prevalence of and risk factors for elevated blood lead levels before resettlement have not been described. METHODS: Blood samples from children aged 6 months to 14 years from refugee camps in Thailand were tested for lead and hemoglobin. Sixty-seven children with elevated blood lead levels (venous ≥10 µg/dL) or undetectable (capillary <3.3 µg/dL) blood lead levels participated in a case-control study. RESULTS: Of 642 children, 33 (5.1%) had elevated blood lead levels. Children aged <2 years had the highest prevalence (14.5%). Among children aged <2 years included in a case-control study, elevated blood lead levels risk factors included hemoglobin <10 g/dL, exposure to car batteries, and taking traditional medicines. CONCLUSIONS: The prevalence of elevated blood lead levels among tested US-bound Burmese refugee children was higher than the current US prevalence, and was especially high among children <2 years old. Refugee children may arrive in the United States with elevated blood lead levels. A population-specific understanding of preexisting lead exposures can enhance postarrival lead-poisoning prevention efforts, based on Centers for Disease Control and Prevention recommendations for resettled refugee children, and can lead to remediation efforts overseas.

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.

A comparison of blood lead levels between migrant and native lead workers before and after implementation of a new employment permit system for migrant workers.

We compared the blood lead and other lead biomarkers between migrant and native workers with a focus on the impact of the legal employment permit system that was effective from 2003, which required employers to provide mandatory annual health examinations for migrant workers on lead biomarkers in 1997 and 2005. The mean blood lead level of migrant workers was 59.5 ± 19.4 µg/dl, yielding 47% of lead poisoning cases, which was significantly higher than that of native workers (36.8 ± 14.5 µg/dl; 11% of lead poisoning cases) in 1997 before enactment of the act. The overall mean blood ZPP levels and ALAU of migrant workers were significantly higher than those of native workers. In 2005, after new migrant worker regulations were instituted, the mean value of above lead biomarkers workers was still significantly higher than that of native workers, but the magnitude of the differences was smaller compared with the difference in 1997. We confirmed that the 2003 regulations played an important role in improving the health of migrant workers in the lead industry in terms of their blood lead levels and other lead biomarkers.

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.

Pediatric lead exposure from imported Indian spices and cultural powders.

BACKGROUND: Significant lead poisoning has been associated with imported nonpaint products. OBJECTIVES: To describe cases of pediatric lead intoxication from imported Indian spices and cultural powders, determine lead concentrations in these products, and predict effects of ingestion on pediatric blood lead levels (BLLs). PATIENTS AND METHODS: Cases and case-study information were obtained from patients followed by the Pediatric Environmental Health Center (Children's Hospital Boston). Imported spices (n = 86) and cultural powders (n = 71) were analyzed for lead by using x-ray fluorescence spectroscopy. The simple bioaccessibility extraction test was used to estimate oral bioavailability. The integrated exposure uptake biokinetic model for lead in children was used to predict population-wide geometric mean BLLs and the probability of elevated BLLs (>10 microg/dL). RESULTS: Four cases of pediatric lead poisoning from Indian spices or cultural powders are described. Twenty-two of 86 spices and foodstuff products contained >1 microg/g lead (for these 22 samples, mean: 2.6 microg/g [95% confidence interval: 1.9-3.3]; maximum: 7.6 microg/g). Forty-six of 71 cultural products contained >1 microg/g lead (for 43 of these samples, mean: 8.0 microg/g [95% confidence interval: 5.2-10.8]; maximum: 41.4 microg/g). Three sindoor products contained >47% lead. With a fixed ingestion of 5 microg/day and 50% bioavailability, predicted geometric mean BLLs for children aged 0 to 4 years increased from 3.2 to 4.1 microg/dL, and predicted prevalence of children with a BLL of >10 microg/dL increased more than threefold (0.8%-2.8%). CONCLUSIONS: Chronic exposure to spices and cultural powders may cause elevated BLLs. A majority of cultural products contained >1 microg/g lead, and some sindoor contained extremely high bioaccessible lead levels. Clinicians should routinely screen for exposure to these products.