Definition

This Indicator Report contains the following variables:[[br]] 1. Percentage/geometric mean of children tested, aged 0 through 5 years with blood lead levels of 5 mcg/dL or greater, or 10 mcg/dL or greater.[[br]] 2. Number/percentage of homes built before 1950.[[br]] 3. Number/percentage of children younger than 5 years living in poverty.

Numerator

1. Total number of children tested, aged 0 through 5 years with a blood lead level of 5mcg/DL or greater, or 10 mcg/dL or greater.[[br]] 2. Total number of homes built before 1950.[[br]] 3. Total number of children younger than 5 years living in poverty.

Denominator

1. Total number of children aged 0 through 5 years tested for blood lead.[[br]] 2. Total number of homes.[[br]] 3. Total number of children younger than 5 years.

Why Is This Important?

Lead poisoning is the most significant and prevalent disease of environmental origin among children living in the United States. Despite considerable knowledge and increased screening and intervention efforts, lead exposures remain prevalent. Environmental lead is a toxic substance that is affecting the growth and development of up to one million U.S. preschool children today, with effects ranging from learning disabilities to death. High levels of lead can cause many health problems by damaging the brain, nervous system, and kidneys. Lead poisoning can cause decreased intelligence, behavioral and speech problems, anemia, decreased muscle and bone growth, poor muscle coordination, and hearing damage. Increased lead exposure and increased body burden of lead remain a significant problem for children in the United States. Lead is an environmental toxicant that may cause adverse health effects to the nervous, hematopoietic, endocrine, renal, and reproductive systems. Lead exposure in young children is particularly hazardous because children absorb lead more readily than adults and many children who are exposed to lead do not exhibit any signs that they have the disease. Any signs or symptoms the child may have could be mistaken for other illnesses and the child goes undiagnosed. The developing nervous system of children is particularly more susceptible to the effects of lead. The underdeveloped blood-brain barrier in young children increases the risk of lead entering the developing nervous system resulting in neurobehavioral disorders. Blood lead levels (BLLs) at any detectable level have been shown to cause behavioral and developmental disorders, therefore no safe blood lead level in children has been identified. It is increasingly important for continued childhood lead poisoning prevention education and awareness. Lead-contaminated water, soil, and paint have been recognized as potential sources of children's lead exposure. Dust from deteriorating lead-based paint is considered to be the largest contributor to the lead problem. Until the 1950s, many homes were covered inside and out with leaded paints. Lead began to fall from favor in the 1950s but was still commonly used until it was banned from use in homes after 1977. Because of the long-term use of lead-based paints, many homes in the United States contain surfaces with paint, which is now peeling, chalking, flaking, or wearing away. The dust or paint chips contain high levels of lead that easily find ways into the mouths of young children. A particular problem has emerged due to a large number of homes with lead-based paints which are now undergoing renovations. Often the dust created by this work has high lead levels which are readily absorbed by the children's developing bodies. Another environmental source of lead in Utah is household dust and soil containing particles of lead from mining waste. Communities built near or on mining and smelting waste piles, where children may play, is a significant source of lead exposure in children.

Healthy People Objective EH-8:

Reduce blood lead levels in children
U.S. target: Not applicable, see subobjectives in this category

Other Objectives

Healthy People 2020 Objective EH-8.1: Reduce blood lead level in children aged 1-5 years[[br]] '''U.S. Target:''' 5.2 ug/dL of lead Healthy People 2020 Objective EH-8.2: Reduce the mean blood lead levels in children[[br]] '''U.S. Target:''' 1.6 ug/dL average blood lead level in children aged 1-5 years[[br]] '''Utah Target:''' 1.2 ug/dL average blood lead level in children aged 0-5 years

What Is Being Done?

The Utah Department of Health Environmental Epidemiology Program (EEP) collaborates with clinical laboratories and point-of-care machine users to report all blood lead tests conducted on Utah residents either on a daily, weekly, or monthly basis. If a child is identified as having a blood lead level of concern (BLLC) the laboratory or the health care provider will notify either the EEP or local health department (LHD) to ensure timely reporting of the BLLC child. The EEP shares the data with all local health departments. The LHD assists the EEP by providing case management of children identified with a BLLC. Surveillance data is kept in the Utah Blood Lead Registry (UBLR) housed in the EEP. Data analysis helps determine trends, prevalence of BLLC children, screening rates among specific high-risk populations, and other areas identified as high-risk, such as older housing and mining communities. The EEP program relies extensively on the LHDs to assist parents/guardians of children who need educational, medical, and environmental assessments. The LHD also serves as a repository of information collected from each BLLC child and provides assistance upon request and coordination with health care providers for follow-up testing and education. Lead poisoning prevention educational materials are distributed by the EEP, LHDs, Baby Your Baby Program, Wee Care Program, Utah Department of Air Quality/Lead-Based Paint Program, Migrant Head Start Program, physicians, and federal agencies such as: Centers for Disease Control and Prevention, Environmental Protection Agency, Housing and Urban Development, and the Agency for Toxic Substances and Disease Registry. Utah Administrative Code R386-703 (Injury Reporting Rule) establishes an injury surveillance and reporting system for major injuries occurring in Utah. Lead poisoning was added to the list of reportable injuries in 1990. Initially, under that rule, lead poisoning injuries were defined to include lead poisoning of all persons with whole blood lead concentrations >= 30 mcg/dL. In 1991, the reportable blood lead level was lowered to >= 15 mcg/dL and lowered to >= 10 mcg/dL in 1997. In 2015, the reporting rule was amended to designate all blood lead tests as reportable, regardless of the result. The reference value used to designate blood lead levels of concern was lowered from 10 mcg/dL to 5 mcg/dL in 2017. The EEP receives reports of blood lead test results, which include the case name, age or birth date, sex, test date, blood lead level, and name of physician or agency. The UBLR was established in 1990 by the Bureau of Epidemiology. In 1992, the Bureau received funding from the National Institute of Occupational Safety and Health (NIOSH) to expand the adult surveillance of blood lead poisoning and to analyze adult lead poisoning epidemiology in Utah. That funding created the ABLES (Adult Blood Lead Epidemiology and Surveillance) project. In 1996 the Bureau received CDC funding to further expand the UBLR by including blood lead testing surveillance in children. The UBLR consists of a relational database with laboratory reports of blood lead test results. The database is maintained by the EEP and entries are categorized for children and adults.

Available Services

The Utah Department of Health Environmental Epidemiology Program is available to answer questions about lead poisoning and provide educational material to the public. Contact your local health department or physician for a blood lead test. If you have any questions please call the Utah Department of Health, Blood Lead Program and ask for Mark Jones at (801) 538-6191.

Health Program Information

To view "Utah's Childhood Blood Lead Screening Recommendations" go to EEP's website at: [http://health.utah.gov/enviroepi/healthyhomes/lead/UCLP.pdf]. Also, for additional information about lead in toys and products visit the above website.

Risk Factors

Major risk factors identified of children with an elevated blood lead level, in decreasing order include: older housing, eating dirt, hand to mouth activities, mining activities/contaminated soil from milling operations, parent's occupation/hobbies, consumer products, folk remedies, and children being exposed to lead prior to coming to the United States.

Data Notes

*BLLC= Blood Lead Level of Concern (>10= mcg/dL prior to 2018, >= 5 mcg/dL 2018 and later). **Blank values indicate no data. Prevalence is calculated as (number of cases with an elevated blood lead level/number of persons tested) x 100. Prior to 1996, results on children were not collected, therefore, this calculation was not made for those years. In 2012, the Centers for Disease Control and Prevention (CDC) updated its childhood blood lead reference value from 10 mcg/dL to 5 mcg/dL. The Utah Environmental Epidemiology Program (EEP) adopted this change in 2017 and began displaying prevalence based on the new reference value in 2018. Prevalence values were calculated for all available data collected prior to 2018 using the updated 5 mcg/dL reference value.

Data Notes

Numerator: Counts from Year 200 U.S. Census [[br]] Denominator: IBIS Population Estimates Query (National Center for Health Statistics [NCHS] through a collaborative agreement with the U.S. Census Bureau, years 2000 to Present)

Data Source

U.S. Bureau of the Census

References and community resources

Utah Department of Health/Environmental Epidemiology Program[[br]] [http://health.utah.gov/epi/enviroepi] Utah Department of Environmental Quality[[br]] [http://www.deq.utah.gov/ProgramsServices/programs/air/lead/index.htm] Centers for Disease Control and Prevention [[br]] [http://www.cdc.gov/nceh/lead] Office of Healthy Homes and Lead Hazard Control (HUD) [[br]] [https://www.hud.gov/healthyhomes] Environmental Protection Agency (EPA) [[br]] [http://www.epa.gov/lead] Consumer Product Safety Commission (lead recalls in consumer products)[[br]] [http://www.cpsc.gov]