Global Health Institute, School of Medicine, Duke University, Durham, North Carolina, USA.
Children's Environmental Health Initiative, University of Illinois Chicago, Chicago, Illinois, USA.
Environ Health Perspect. 2024 Sep;132(9):97003. doi: 10.1289/EHP13898. Epub 2024 Sep 3.
Exposure to lead during childhood is detrimental to children's health. The extent to which the association between lead exposure and elementary school academic outcomes varies across geography is not known.
Estimate associations between blood lead levels (BLLs) and fourth grade standardized test scores in reading and mathematics in North Carolina using models that allow associations between BLL and test scores to vary spatially across communities.
We link geocoded, individual-level, standardized test score data for North Carolina public school students in fourth grade (2013-2016) with detailed birth records and blood lead testing data retrieved from the North Carolina childhood blood lead state registry on samples typically collected at 1-6 y of age. BLLs were categorized as: (reference), , and . We then fit spatially varying coefficient models that incorporate information sharing (smoothness), across neighboring communities via a Gaussian Markov random field to provide a global estimate of the association between BLL and test scores, as well as census tract-specific estimates (i.e., spatial coefficients). Models adjusted for maternal- and child-level covariates and were fit separately for reading and math.
The average BLL across the 91,706 individuals in the analysis dataset was . Individuals were distributed across 2,002 (out of 2,195) census tracts in North Carolina. In models adjusting for child sex, birth weight percentile for gestational age, and Medicaid participation as well as maternal race/ethnicity, educational attainment, marital status, and tobacco use, BLLs of , and were associated with overall lower reading test scores of [95% confidence interval (CI): , ], (, ), and (, ), respectively. For BLLs of , , and , spatial coefficients-that is, tract-specific adjustments in reading test score relative to the "global" coefficient-ranged from to 2.52, to 3.90, to 7.85, and to 4.33, respectively. Results for mathematics were similar to those for reading.
The association between lead exposure and reading and mathematics test scores exhibits considerable heterogeneity across North Carolina communities. These results emphasize the need for prevention and mitigation efforts with respect to lead exposures everywhere, with special attention to locations where the cognitive impact is elevated. https://doi.org/10.1289/EHP13898.
儿童时期接触铅会对儿童健康造成危害。但目前尚不清楚铅暴露与小学学业成绩之间的关联在地理上的差异程度。
使用允许血铅水平（BLL）与测试成绩之间的关联在社区之间存在空间差异的模型，估计北卡罗来纳州 BLL 与四年级标准化考试阅读和数学成绩之间的关联。
我们将北卡罗来纳州公立学校四年级学生的地理编码、个体水平的标准化考试成绩数据（2013-2016 年）与从北卡罗来纳州儿童血铅州登记处获取的详细出生记录和血铅检测数据相链接，这些数据通常是在 1-6 岁时采集的。BLL 被分为以下几类：（参考）、、和。然后，我们拟合空间变化系数模型，该模型通过高斯马尔可夫随机场在相邻社区之间共享信息（平滑性），提供 BLL 与测试成绩之间关联的全局估计，以及普查区特定的估计值（即空间系数）。模型调整了母亲和儿童水平的协变量，并分别为阅读和数学进行了拟合。
在分析数据集的 91706 个人中，平均 BLL 为。个体分布在北卡罗来纳州的 2002 个（2195 个）普查区中。在调整儿童性别、胎龄出生体重百分位数和医疗补助参与情况以及母亲种族/民族、教育程度、婚姻状况和吸烟情况的模型中，BLL 为、和分别与阅读测试总分较低相关，分别为[95%置信区间（CI）：，]、（，）和（，）。对于 BLL 为、、和，相对于“全局”系数，阅读测试成绩的普查区特定调整系数（即空间系数）范围从 到 2.52、从 到 3.90、从 到 7.85 和从 到 4.33。数学的结果与阅读相似。
铅暴露与阅读和数学测试成绩之间的关联在北卡罗来纳州社区之间存在显著的异质性。这些结果强调了在任何地方都需要进行针对铅暴露的预防和缓解工作，特别需要关注认知影响升高的地区。https://doi.org/10.1289/EHP13898.
