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Residential dust lead levels and the risk of childhood lead poisoning in United States children

A Correction to this article was published on 30 October 2020

This article has been updated

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

The EPA’s residential dust lead regulations place children at increased risk of lead poisoning. We recommend adopting more protective dust lead standards.

Impact

  • 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.

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Fig. 1: Adjusted geometric mean (GM) children’s blood lead concentrations as a function of floor and windowsill dust lead loadings at 1 and 2 years of age (the HOME Study).
Fig. 2: Adjusted risk of elevated blood lead concentrations (≥5μg/dL) as a function of floor and windowsill dust lead loadings at 1 and 2 years of age (the HOME Study).

Change history

References

  1. Centers for Disease Control and Prevention. Lead: CDC’s National Surveillance Data (1997–2015) (Centers for Disease Control and Prevention, 2016).

  2. Bellinger, D. C. & Bellinger, A. M. Childhood lead poisoning: the torturous path from science to policy. J. Clin. Invest. 116, 853–857 (2006).

    CAS  Article  Google Scholar 

  3. 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).

    CAS  Article  Google Scholar 

  4. 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).

  5. ACoCLP Prevention. Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention (Centers for Disease Control and Prevention, 2012).

  6. Reuben, A. et al. Association of childhood lead exposure with adult personality traits and lifelong mental health. JAMA Psychiatry 76, 418–425 (2019).

    Article  Google Scholar 

  7. 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).

    CAS  Article  Google Scholar 

  8. 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).

    CAS  Article  Google Scholar 

  9. 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).

    Article  Google Scholar 

  10. NT Program. Health Effects of Low-Level Lead (US Department of Health and Human Services, 2012).

  11. Wright, J. P. et al. Association of prenatal and childhood blood lead concentrations with criminal arrests in early adulthood. PLoS Med 5, e101 (2008).

    Article  Google Scholar 

  12. USCoAftN Circuit. A Community Voice v. EPA, No. 16-72816, Order (2018).

  13. USCoAftN Circuit. A Community Voice v. EPA, No. 16-72816, Opinion (2017).

  14. Wheeler, A. Review of the Dust-Lead Hazards Standards and the Definition of Lead-Based Paint (USEP Agency, 2019).

  15. NTP Program. NTP monograph on health effects of low-level lead. NTP Monogr. 1, xiii, xv-148 (2012).

  16. Braun, J. M. et al. Cohort profile: the Health Outcomes and Measures of the Environment (HOME) study. Int. J. Epidemiol. 46, 24 (2017).

    PubMed  Google Scholar 

  17. 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).

    PubMed  Google Scholar 

  18. Levin, R. et al. Lead exposures in U.S. Children, 2008: implications for prevention. Environ. Health Perspect. 116, 1285–1293 (2008).

    CAS  Article  Google Scholar 

  19. 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).

    Article  Google Scholar 

  20. 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).

    Article  Google Scholar 

  21. USEP Agency. Lead; Identification of Dangerous Levels of Lead; Final Rule. 40 CFR Part 745. Federal Register 1205–1240 (2001).

  22. USDoHaU Development. Revised Dust-Lead Action Levels for Risk Assessment and Clearance; Clearance of Porch Floors (USDoHaU Development, 2017).

  23. HUD. Evaluation and Control of Lead-Based Paint Hazards in Housing (US Department of Housing and Urban Development, Washington, 1995).

  24. 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).

    CAS  Article  Google Scholar 

  25. Zou, G. A modified poisson regression approach to prospective studies with binary data. Am. J. Epidemiol. 159, 702–706 (2004).

    Article  Google Scholar 

  26. CACoCLP Prevention. Low Level Lead Exposure Harms Children: A Renewed Call For Primary Prevention (US Department of Health and Human Services, CDC, Atlanta, 2012).

  27. Hanley, J. A. A heuristic approach to the formulas for population attributable fraction. J. Epidemiol. Community Health 55, 508–514 (2001).

    CAS  Article  Google Scholar 

  28. 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).

    CAS  Article  Google Scholar 

  29. 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).

    CAS  Article  Google Scholar 

  30. 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).

    CAS  Article  Google Scholar 

  31. Lanphear, B. P. et al. Lead-contaminated house dust and urban children’s blood lead levels. Am. J. Public Health 86, 1416–1421 (1996).

    CAS  Article  Google Scholar 

  32. 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).

  33. USDoHaU Development. Revised Dust-Lead Action Levels for Risk Assessment and Clearance; Clearance of Porch Floors (USDoHaU Development, Washington, 2017).

  34. 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).

    CAS  Article  Google Scholar 

  35. Jacobs, D. E. et al. The prevalence of lead-based paint hazards in U.S. housing. Environ. Health Perspect. 110, A599–A606 (2002).

    CAS  Article  Google Scholar 

  36. Lanphear, B. P., Hornung, R. & Ho, M. Screening housing to prevent lead toxicity in children. Public Health Rep. 120, 305–310 (2005).

    Article  Google Scholar 

  37. Bearer, C. F. How are children different from adults? Environ. Health Perspect. 103(Suppl. 6), 7–12 (1995).

    Article  Google Scholar 

  38. 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).

    CAS  Article  Google Scholar 

  39. Paulson, J. A. & Brown, M. J. The CDC blood lead reference value for children: time for a change. Environ. Health 18, 16 (2019).

    Article  Google Scholar 

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Acknowledgements

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.

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Authors and Affiliations

Authors

Contributions

K.Y., N.N., D.E.J., and B.P.L. contributed to the study conception and design, as well as acquisition of the data. J.M.B. conducted the statistical analyses and drafted the manuscript. J.M.B., K.Y., N.N., D.E.J., M.T., and B.P.L. all contributed to the interpretation of the data and revising the manuscript. All authors approve of the submitted version.

Corresponding author

Correspondence to Joseph M. Braun.

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Competing interests

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.

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Research assistants explained study protocols to prospective participants before obtaining written informed consent for women and their children.

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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

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