The United States Environmental Protection Agency (EPA) recently lowered residential floor and windowsill dust lead hazard standards, but maintained previous post-abatement clearance standards. We examined whether the discrepancy in these regulations places children at higher risk of lead poisoning.
In 250 children from Cincinnati, Ohio (2004–2008) living in homes built before 1978, we measured residential floor and windowsill dust lead loadings and blood lead concentrations at ages 1 and 2 years. Using linear regression with generalized estimating equations, we estimated covariate-adjusted associations of dust lead levels with blood lead concentrations and risk of lead poisoning.
An increase in floor dust lead from 10 (revised dust lead hazard standard) to 40 μg/ft2 (post-abatement clearance standard) was associated with 26% higher (95% confidence interval (CI):15, 38) blood lead concentrations and 2.1 times the risk of blood lead concentrations ≥5 μg/dL (95% CI: 1.44, 3.06). Extrapolating our findings to US children age 1–5 years, we estimated that 6.9% (95% CI: 1.5, 17.2) of cases of blood lead concentrations ≥5 μg/dL are attributable to floor dust lead loadings between 10 and ≤40 μg/ft2.
The EPA’s residential dust lead regulations place children at increased risk of lead poisoning. We recommend adopting more protective dust lead standards.
We determined whether children are at increased risk of lead poisoning with the 2019 EPA residential post-abatement lead clearance standards being higher than dust lead hazard standards.
In this observational study, 2019 EPA dust lead clearance standards were associated with increased risk of lead poisoning compared to the revised dust lead hazard standard. Both EPA standards were associated with increased risk of lead poisoning compared to more stringent standards employed in our study.
Extrapolating our findings to US children, the 2019 EPA dust lead clearance standards could place up to 36,700 children at risk of lead poisoning.
This is a preview of subscription content
Subscribe to Journal
Get full journal access for 1 year
only $9.15 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
Centers for Disease Control and Prevention. Lead: CDC’s National Surveillance Data (1997–2015) (Centers for Disease Control and Prevention, 2016).
Bellinger, D. C. & Bellinger, A. M. Childhood lead poisoning: the torturous path from science to policy. J. Clin. Invest. 116, 853–857 (2006).
Hwang, Y. H., Hsiao, C. K. & Lin, P. W. Globally temporal transitions of blood lead levels of preschool children across countries of different categories of Human Development Index. Sci. Total Environ. 659, 1395–1402 (2019).
Centers for Disease Control and Prevention. Blood lead levels in children aged 1–5 years—United States, 1999–2010. MMWR Morb. Mortal Wkly Rep. 62, 245–248 (2013).
ACoCLP Prevention. Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention (Centers for Disease Control and Prevention, 2012).
Reuben, A. et al. Association of childhood lead exposure with adult personality traits and lifelong mental health. JAMA Psychiatry 76, 418–425 (2019).
Reuben, A. et al. Association of childhood blood lead levels with cognitive function and socioeconomic status at age 38 years and with IQ change and socioeconomic mobility between childhood and adulthood. JAMA 317, 1244–1251 (2017).
Lanphear, B. P. et al. Low-level environmental lead exposure and children’s intellectual function: an international pooled analysis. Environ. Health Perspect. 113, 894–899 (2005).
Braun, J. M. et al. Exposures to environmental toxicants and attention deficit hyperactivity disorder in U.S. children. Environ. Health Perspect. 114, 1904–1909 (2006).
NT Program. Health Effects of Low-Level Lead (US Department of Health and Human Services, 2012).
Wright, J. P. et al. Association of prenatal and childhood blood lead concentrations with criminal arrests in early adulthood. PLoS Med 5, e101 (2008).
USCoAftN Circuit. A Community Voice v. EPA, No. 16-72816, Order (2018).
USCoAftN Circuit. A Community Voice v. EPA, No. 16-72816, Opinion (2017).
Wheeler, A. Review of the Dust-Lead Hazards Standards and the Definition of Lead-Based Paint (USEP Agency, 2019).
NTP Program. NTP monograph on health effects of low-level lead. NTP Monogr. 1, xiii, xv-148 (2012).
Braun, J. M. et al. Cohort profile: the Health Outcomes and Measures of the Environment (HOME) study. Int. J. Epidemiol. 46, 24 (2017).
Raymond, J. et al. Lead screening and prevalence of blood lead levels in childrenaged 1-2 years—Child Blood Lead Surveillance System, United States, 2002–2010 and National Health and Nutrition Examination Survey, United States, 1999–2010. MMWR Suppl. 63, 36–42 (2014).
Levin, R. et al. Lead exposures in U.S. Children, 2008: implications for prevention. Environ. Health Perspect. 116, 1285–1293 (2008).
Phelan, K. J. et al. A randomized controlled trial of home injury hazard reduction: the HOME injury study. Arch. Pediatr. Adolesc. Med. 165, 339–345 (2011).
Braun, J. M. et al. Effect of residential lead-hazard interventions on childhood blood lead concentrations and neurobehavioral outcomes: a Randomized Clinical Trial. JAMA Pediatr. 172, 934–942 (2018).
USEP Agency. Lead; Identification of Dangerous Levels of Lead; Final Rule. 40 CFR Part 745. Federal Register 1205–1240 (2001).
USDoHaU Development. Revised Dust-Lead Action Levels for Risk Assessment and Clearance; Clearance of Porch Floors (USDoHaU Development, 2017).
HUD. Evaluation and Control of Lead-Based Paint Hazards in Housing (US Department of Housing and Urban Development, Washington, 1995).
Jones, D. R. et al. Analysis of whole human blood for Pb, Cd, Hg, Se, and Mn by ICP-DRC-MS for biomonitoring and acute exposures. Talanta 162, 114–122 (2017).
Zou, G. A modified poisson regression approach to prospective studies with binary data. Am. J. Epidemiol. 159, 702–706 (2004).
CACoCLP Prevention. Low Level Lead Exposure Harms Children: A Renewed Call For Primary Prevention (US Department of Health and Human Services, CDC, Atlanta, 2012).
Hanley, J. A. A heuristic approach to the formulas for population attributable fraction. J. Epidemiol. Community Health 55, 508–514 (2001).
Dixon, S. L. et al. Exposure of U.S. children to residential dust lead, 1999–2004: II. The contribution of lead-contaminated dust to children’s blood lead levels. Environ. Health Perspect. 117, 468–474 (2009).
Haycock, G. B., Schwartz, G. J. & Wisotsky, D. H. Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults. J. Pediatr. 93, 62–66 (1978).
Lanphear, B. P. et al. The contribution of lead-contaminated house dust and residential soil to children’s blood lead levels. A pooled analysis of 12 epidemiologic studies. Environ. Res. 79, 51–68 (1998).
Lanphear, B. P. et al. Lead-contaminated house dust and urban children’s blood lead levels. Am. J. Public Health 86, 1416–1421 (1996).
HUD. Lead Hazard Control Survey (US Department of Housing and Urban Development, Office of Lead Hazard Control and Healthy Homes). https://www.hud.gov/sites/documents/CLEARANCESURVEY_24OCT15.PDF (2015).
USDoHaU Development. Revised Dust-Lead Action Levels for Risk Assessment and Clearance; Clearance of Porch Floors (USDoHaU Development, Washington, 2017).
Gaitens, J. M. et al. Exposure of U.S. children to residential dust lead, 1999–2004: I. Housing and demographic factors. Environ. Health Perspect. 117, 461–467 (2009).
Jacobs, D. E. et al. The prevalence of lead-based paint hazards in U.S. housing. Environ. Health Perspect. 110, A599–A606 (2002).
Lanphear, B. P., Hornung, R. & Ho, M. Screening housing to prevent lead toxicity in children. Public Health Rep. 120, 305–310 (2005).
Bearer, C. F. How are children different from adults? Environ. Health Perspect. 103(Suppl. 6), 7–12 (1995).
Clark, S. et al. Occurrence and determinants of increases in blood lead levels in children shortly after lead hazard control activities. Environ. Res. 96, 196–205 (2004).
Paulson, J. A. & Brown, M. J. The CDC blood lead reference value for children: time for a change. Environ. Health 18, 16 (2019).
The HOME Study was supported by grants from the National Institutes of Environmental Health Sciences (P01 ES011261 and R01 ES014575) and United States Environmental Protection Agency (RD—83544201). Housing remediation costs were supported by the United States Department of Housing and Urban Development through an interagency agreement.
B.P.L. served as an expert witness in cases related to childhood lead poisoning, but he has not personally received any compensation for these services. J.M.B. was financially compensated for serving as an expert witness for plaintiffs in litigation related to tobacco smoke exposures and received a honoraria for serving on an advisory board to Quest Diagnostics. M.T. was compensated for providing expert advice to lawyers in cases related to childhood lead poisoning and to the New South Wales EPA Broken Hill Environmental Lead Program. D.E.J. was compensated providing expert testimony in lead poisoning cases. N.N. receives research funding from Meridian Biosciences and was compensated for providing expert advice in a lead exposure case. The authors have no conflicts of interest.
Research assistants explained study protocols to prospective participants before obtaining written informed consent for women and their children.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Braun, J.M., Yolton, K., Newman, N. et al. Residential dust lead levels and the risk of childhood lead poisoning in United States children. Pediatr Res 90, 896–902 (2021). https://doi.org/10.1038/s41390-020-1091-3
Associations between perfluoroalkyl acids in serum and lead and mercury in whole blood among US children aged 3–11 years
Environmental Science and Pollution Research (2021)