2014年费城社区儿童铅暴露情况评估
Assessment of Child Lead Exposure in a Philadelphia Community, 2014.
作者信息
Dignam Timothy, Pomales Ana, Werner Lora, Newbern E Claire, Hodge James, Nielsen Jay, Grober Aaron, Scruton Karen, Young Rand, Kelly Jack, Brown Mary Jean
机构信息
Divisions of Environmental Hazards and Health Effects (Dr Dignam) and Emergency and Environmental Health Services (Messrs Hodge and Nielsen and Dr Brown), National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Region 3 (Mss Pomales and Werner), Division of Community Health Investigations (Mr Grober and Ms Scruton), and Division of Toxicology and Human Health Studies (Mr Young), Agency for Toxic Substances and Disease Registry, Atlanta, Georgia; Philadelphia Department of Public Health, Philadelphia, Pennsylvania (Dr Newbern); and Region 3, Environmental Protection Agency, Philadelphia, Pennsylvania (Mr Kelly).
出版信息
J Public Health Manag Pract. 2019 Jan/Feb;25(1):53-61. doi: 10.1097/PHH.0000000000000711.
INTRODUCTION
Several urban neighborhoods in Philadelphia, Pennsylvania, have a history of soil, household lead paint, and potential lead-emitting industry contamination.
OBJECTIVES
To (1) describe blood lead levels (BLLs) in target neighborhoods, (2) identify risk factors and sources of lead exposure, (3) describe household environmental lead levels, and (4) compare results with existing data.
METHODS
A simple, random, cross-sectional sampling strategy was used to enroll children 8 years or younger living in selected Philadelphia neighborhoods with a history of lead-emitting industry during July 2014. Geometric mean of child BLLs and prevalence of BLLs of 5 μg/dL or more were calculated. Linear and logistic regression analyses were used to ascertain risk factors for elevated BLLs.
RESULTS
Among 104 children tested for blood lead, 13 (12.4%; 95% confidence interval [CI], 7.5-20.2) had BLLs of 5 μg/dL or more. The geometric mean BLL was 2.0 μg/dL (95% CI, 1.7-2.3 μg/dL). Higher geometric mean BLLs were significantly associated with front door entryway dust lead content, residence built prior to 1900, and a child currently or ever receiving Medicaid. Seventy-one percent of households exceeded the screening level for soil, 25% had an elevated front door floor dust lead level, 28% had an elevated child play area floor dust lead level, and 14% had an elevated interior window dust lead level. Children in households with 2 to 3 elevated environmental lead samples were more likely to have BLLs of 5 μg/dL or more. A spatial relationship between household proximity to historic lead-emitting facilities and child BLL was not identified.
CONCLUSION
Entryway floor dust lead levels were strongly associated with blood lead levels in participants. Results underscore the importance to make housing lead safe by addressing all lead hazards in and around the home. Reduction of child lead exposure is crucial, and continued blood lead surveillance, testing, and inspection of homes of children with BLLs of 5 μg/dL or more to identify and control lead sources are recommended. Pediatric health care providers can be especially vigilant screening Medicaid-eligible/enrolled children and children living in very old housing.
引言
宾夕法尼亚州费城的几个城市社区存在土壤、家用铅漆以及潜在的铅排放行业污染历史。
目的
（1）描述目标社区儿童的血铅水平（BLLs）；（2）确定铅暴露的风险因素和来源；（3）描述家庭环境铅水平；（4）将结果与现有数据进行比较。
方法
采用简单随机横断面抽样策略，纳入2014年7月居住在费城选定的有铅排放行业历史社区的8岁及以下儿童。计算儿童BLLs的几何均值以及BLLs达到或超过5μg/dL的患病率。采用线性和逻辑回归分析确定BLLs升高的风险因素。
结果
在104名接受血铅检测的儿童中，13名（12.4%；95%置信区间[CI]，7.5 - 20.2）的BLLs达到或超过5μg/dL。几何平均BLL为2.0μg/dL（95%CI，1.7 - 2.3μg/dL）。较高的几何平均BLLs与前门入口处灰尘铅含量、1900年以前建造的住宅以及目前或曾经接受医疗补助的儿童显著相关。71%的家庭土壤筛查水平超标，25%的家庭前门地板灰尘铅水平升高，28%的家庭儿童游乐区地板灰尘铅水平升高，14%的家庭室内窗户灰尘铅水平升高。家庭中有2至3个环境铅样本升高的儿童更有可能BLLs达到或超过5μg/dL。未发现家庭与历史铅排放设施的距离与儿童BLL之间存在空间关系。
结论
入口处地板灰尘铅水平与参与者的血铅水平密切相关。结果强调了通过解决家庭内外所有铅危害来使住房铅安全的重要性。减少儿童铅暴露至关重要，建议持续进行血铅监测、检测，并对BLLs达到或超过5μg/dL的儿童家庭进行检查，以识别和控制铅源。儿科医疗保健提供者在筛查符合医疗补助资格/已登记的儿童以及居住在非常老旧住房中的儿童时应格外警惕。
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