Jones Robert L, Homa David M, Meyer Pamela A, Brody Debra J, Caldwell Kathleen L, Pirkle James L, Brown Mary Jean
Centers for Disease Control and Prevention, National Center for Environmental Health, 4770 Buford Hwy, Atlanta, GA 30341.
Pediatrics. 2009 Mar;123(3):e376-85. doi: 10.1542/peds.2007-3608.
To evaluate trends in children's blood lead levels and the extent of blood lead testing of children at risk for lead poisoning from national surveys conducted during a 16-year period in the United States.
Data for children aged 1 to 5 years from the National Health and Nutrition Examination Survey III Phase I, 1988-1991, and Phase II, 1991-1994 were compared to data from the survey period 1999-2004.
The prevalence of elevated blood lead levels, >/=10 microg/dL, among children decreased from 8.6% in 1988-1991 to 1.4% in 1999-2004, which is an 84% decline. From 1988-1991 and 1999-2004, children's geometric mean blood lead levels declined in non-Hispanic black (5.2-2.8 microg/dL), Mexican American (3.9-1.9 microg/dL), and non-Hispanic white children (3.1 microg/dL to 1.7 microg/dL). However, levels continue to be highest among non-Hispanic black children relative to Mexican American and non-Hispanic white children. Blood lead levels were distributed as follows: 14.0% were <1.0 microg/dL, 55.0% were 1.0 to <2.5 microg/dL, 23.6% were 2.5 to <5 microg/dL, 4.5% were 5 to <7.5 microg/dL, 1.5% were 7.5 to <10 microg/dL, and 1.4% were >/=10 microg/dL. Multivariable analysis indicated that residence in older housing, poverty, age, and being non-Hispanic black are still major risk factors for higher lead levels. Blood lead testing of Medicaid-enrolled children increased to 41.9% from 19.2% in 1988-1991. Only 43.0% of children with elevated blood lead levels had previously been tested.
Children's blood lead levels continue to decline in the United States, even in historically high-risk groups for lead poisoning. To maintain progress made and eliminate remaining disparities, efforts must continue to test children at high risk for lead poisoning, and identify and control sources of lead. Coordinated prevention strategies at national, state, and local levels will help achieve the goal of elimination of elevated blood lead levels.
通过对美国16年间全国性调查数据的分析，评估儿童血铅水平的变化趋势以及铅中毒高危儿童的血铅检测情况。
将1988 - 1991年和1991 - 1994年国家健康和营养检查调查（NHANES）III期第一阶段和第二阶段中1至5岁儿童的数据，与1999 - 2004年调查期间的数据进行比较。
血铅水平升高（≥10微克/分升）的儿童患病率从1988 - 1991年的8.6%降至1999 - 2004年的1.4%，降幅达84%。1988 - 1991年至1999 - 2004年期间，非西班牙裔黑人儿童（从5.2微克/分升降至2.8微克/分升）、墨西哥裔美国儿童（从3.9微克/分升降至1.9微克/分升）和非西班牙裔白人儿童（从3.1微克/分升降至1.7微克/分升）的几何平均血铅水平均有所下降。然而，与墨西哥裔美国儿童和非西班牙裔白人儿童相比，非西班牙裔黑人儿童的血铅水平仍然最高。血铅水平分布如下：14.0%低于1.0微克/分升，55.0%在1.0至<2.5微克/分升之间，23.6%在2.5至<5微克/分升之间，4.5%在5至<7.5微克/分升之间，1.5%在7.5至<10微克/分升之间，1.4%≥10微克/分升。多变量分析表明，居住在老旧住房、贫困、年龄以及非西班牙裔黑人身份仍是血铅水平较高的主要危险因素。参加医疗补助计划儿童的血铅检测率从1988 - 1991年的19.2%升至41.9%。仅有43.0%血铅水平升高的儿童此前接受过检测。
在美国，即使在铅中毒历史高危人群中，儿童血铅水平仍在持续下降。为保持已取得的进展并消除剩余差距，必须继续努力对铅中毒高危儿童进行检测，识别并控制铅源。国家、州和地方层面的协调预防策略将有助于实现消除血铅水平升高这一目标。
