Quest Diagnostics, Secaucus, New Jersey, USA.
Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.
Popul Health Manag. 2024 Jun;27(3):199-205. doi: 10.1089/pop.2023.0298. Epub 2024 Apr 8.
The study objective was to evaluate the impact of the coronavirus disease (COVID-19) pandemic on pediatric blood lead testing in the United States. Clinical laboratory pediatric (ages <6 years) blood lead level (BLL) tests performed by Quest Diagnostics, January 2019-March 2022, were analyzed. Patients were categorized by age, by sex, and, through matching by ZIP code with US Census data, for race, ethnicity, pre-1950 housing, and poverty estimates. Over 2.8 million results from children (<6 years old) from all 50 states and the District of Columbia were included. Compared to March-May 2019, BLL testing was lower by 53.6% in March-May 2020 and lower by 14.6% in March-May 2021. Testing rebounded more for children in predominantly White non-Hispanic communities and among children living in communities, based on ZIP codes, with the least pre-1950 housing stock and lowest poverty rates. The proportion of children with BLL at or above the United States Centers for Disease Control and Prevention reference values of 3.5 and 5.0 µg/dL fell by 19% and 24%, respectively, in 2021 versus 2019. In conclusion, pediatric BLL testing has rebounded from sharp declines during the early pandemic period but unevenly. Declines in the proportion of children with elevated BLL should be interpreted with caution, as testing rebounds were less robust among communities with the highest risk of lead poisoning, notably communities with the oldest housing stock and higher poverty rates. More public health efforts are needed to address lead toxicity throughout the United States, especially in communities that did not experience a full rebound subsequent to the early COVID-19 pandemic period.
本研究旨在评估 2019 冠状病毒病（COVID-19）大流行对美国儿童血铅检测的影响。分析了 Quest Diagnostics 于 2019 年 1 月至 2022 年 3 月期间进行的临床实验室儿科（年龄<6 岁）血铅水平（BLL）检测。根据年龄、性别以及通过邮政编码与美国人口普查数据匹配的种族、民族、1950 年前住房和贫困估计值对患者进行分类。共纳入来自全美 50 个州和哥伦比亚特区的 280 多万名儿童（<6 岁）的检测结果。与 2019 年 3 月至 5 月相比，2020 年 3 月至 5 月的 BLL 检测量下降了 53.6%，2021 年 3 月至 5 月的检测量下降了 14.6%。根据邮政编码，在以白人非西班牙裔为主的社区和住房存量最少、贫困率最低的社区中，儿童的检测量反弹更为明显。与美国疾病控制与预防中心（Centers for Disease Control and Prevention）参考值 3.5µg/dL 和 5.0µg/dL 相比，2021 年血铅水平在或以上的儿童比例分别下降了 19%和 24%，而 2019 年则上升了 19%和 24%。总之，儿科 BLL 检测量从大流行早期的急剧下降中有所反弹，但仍不均衡。需要谨慎解读儿童血铅水平升高比例的下降情况，因为在那些铅中毒风险最高的社区，尤其是那些住房最陈旧、贫困率最高的社区，检测量的反弹并不强劲。美国需要加大公共卫生力度来解决铅中毒问题，尤其是在那些没有在 COVID-19 大流行早期之后完全反弹的社区。
