Childhood blood lead screening in Arkansas: recommendations for health care providers.

Multiple studies documenting regional differences in prevalence of elevated blood lead levels suggest that children are not at equal risk for lead exposure. In late 1997, the Centers for Disease Control and Prevention (CDC) published guidelines to help states and communities make decisions regarding screening practices. To apply these guidelines to Arkansas Department of Health blood lead data for the 8,883 screens completed in state fiscal year 1997, along with 1990 Census Bureau housing and poverty statistics, were compiled and reviewed. Based upon CDC criteria and other available information, conservative recommendations for blood lead screening are presented for each county in the state. Lead toxicity in children remains a significant public health concern in certain regions of the country. Between 1991-1994, it was estimated about 930,000 U.S. children one to five years old had lead levels > or = 10 micrograms/dL. Children most at risk include minorities, those residing in large central cities, and those living in poverty. Blood lead levels (BLL's) as low as 10 micrograms/dL have been linked with possible IQ deficits as well as learning and behavior problems. To date, no study has demonstrated benefit from reduction of blood lead levels in the 10-24 micrograms/dL range. Nonetheless, in 1991 the Centers for Disease Control and Prevention (CDC) published guidelines for screening and followup designed to detect lead levels this low, presumably in order to prevent additional exposure and perhaps shorten the duration of toxicity. These guidelines essentially called for universal screening of one- and two-year old children regardless of socioeconomic status or previous population-based results of lead screening in their locale. [table: see text] Since release of the controversial 1991 guidelines, several reports of lead toxicity prevalence surveys from diverse communities have demonstrated extreme variation in the magnitude of the problem. For example, in 1994 only 0.6% of Alaska Medicaid recipients six years or younger had lead levels > or = 10 micrograms/dL, with the highest being 11 micrograms/dL.