Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, KP Gray, S Reagan, F Bayuh, and M Hauptman), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (RCL Brewster and N Buncher), Boston Medical Center, Boston, Mass; Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, and M Hauptman), Harvard Medical School, Boston, Mass.
Department of Ophthalmology (AD Azad), Massachusetts Eye and Ear, Boston, Mass.
Acad Pediatr. 2024 Jul;24(5):810-814. doi: 10.1016/j.acap.2023.11.014. Epub 2023 Nov 17.
To evaluate the effect of the COVID-19 pandemic on childhood lead testing and blood lead levels.
A retrospective analysis of lead tests and results was performed across 3 urban medical centers during the pre-COVID-19 (March 10, 2019-March 9, 2020) and COVID-19 (March 10, 2020-March 10, 2022) periods. Interrupted time series analysis with quasi-Poisson regression was used to evaluate changes in lead testing between study periods. The relationship between sociodemographic features with detectable (≧2 µg/dL) and elevated (≧3.5 µg/dL) blood lead levels (BLLs) was assessed with multivariable logistic regression.
Among a total of 16,364 lead tests across 10,362 patients, weekly testing rates significantly decreased during COVID-19 (relative risk (RR) 0.64, 95% (confidence interval) CI 0.53-0.78). Census tracts with the greatest proportion of pre-1950s housing had a stronger association with detectable BLLs during the COVID-19 period (pre-COVID-19 adjusted odds ratio (aOR) 1.73, 95% CI 1.35-2.20; aOR 2.58, 95% CI 2.13-3.12; interaction P value .014). When limited to 1 year following COVID-19 (March 10, 2020-March 10, 2021), the association between both elevated BLLs (pre-COVID-19: aOR 1.49, 95% CI 0.87-2.53; COVID-19: aOR 3.51, 95% CI 1.98-6.25; interaction P value .032) and detectable BLLs with pre-1950s housing were greater during the COVID-19 period (pre-COVID-19: aOR 1.73, 95% CI 1.35-2.20; COVID-19: aOR 2.56, 95% CI 1.95-3.34; interaction P value .034).
The COVID-19 pandemic led to a significant reduction in lead surveillance and magnified the effect of known risk factors for lead exposure. Concerted clinical, public health, and community advocacy are needed to address care gaps and excess cases of lead poisoning.
评估 COVID-19 大流行对儿童铅检测和血铅水平的影响。
对 3 家城市医疗中心在 COVID-19 大流行前（2019 年 3 月 10 日至 2020 年 3 月 9 日）和 COVID-19 大流行期间（2020 年 3 月 10 日至 2022 年 3 月 10 日）进行了铅检测和结果的回顾性分析。使用准泊松回归的中断时间序列分析来评估研究期间铅检测的变化。使用多变量逻辑回归评估社会人口特征与可检测到（≧2μg/dL）和升高（≧3.5μg/dL）血铅水平（BLL）之间的关系。
在总共 16364 次针对 10362 名患者的铅检测中，COVID-19 期间每周检测率显著下降（相对风险 (RR) 0.64，95%置信区间 (CI) 0.53-0.78）。在前 COVID-19 时期，前 1950 年代住房比例最高的普查区与可检测到的 BLL 之间存在更强的关联（COVID-19 调整后的优势比（aOR）1.73，95%CI 1.35-2.20；aOR 2.58，95%CI 2.13-3.12；交互 P 值.014）。当仅考虑 COVID-19 后 1 年（2020 年 3 月 10 日至 2021 年 3 月 10 日）时，前 COVID-19 时期（aOR 1.49，95%CI 0.87-2.53；COVID-19：aOR 3.51，95%CI 1.98-6.25；交互 P 值.032）和 COVID-19 时期（aOR 1.73，95%CI 1.35-2.20；aOR 2.56，95%CI 1.95-3.34；交互 P 值.034）之间与前 1950 年代住房有关的 BLL 升高与可检测到的 BLL 之间的关联更强。
COVID-19 大流行导致铅监测显著减少，并放大了已知铅暴露风险因素的影响。需要临床、公共卫生和社区宣传的协同努力，以解决护理差距和铅中毒的过度病例。
