Snyder D C, Mohle-Boetani J C, Palla B, Fenstersheib M
Department of Public Health, Santa Clara Valley Health and Hospital System, San Jose, California, USA.
Pediatrics. 1995 Oct;96(4 Pt 1):643-8.
To determine: (1) the prevalence of a blood lead level (PbB) of 10 micrograms/dL or greater and 20 micrograms/dL or greater among children aged 6 to 72 months attending the Santa Clara County (SCC), California, public clinics, (2) risk factors for elevated PbB in this population, and (3) whether an SCC public clinic population-specific risk-assessment tool and a five-question lead poisoning questionnaire developed by the Centers for Disease Control and Prevention are useful for prospectively identifying children at higher risk for elevated PbB.
We tested for PbB 3630 children aged 6 to 72 months attending SCC public outpatient clinics between August 8, 1991, and September 1, 1992. We then conducted two matched case-control studies. Five local risk-factor questions were combined with the CDC's five-question lead poisoning questionnaire, and from May 1, 1993, to June 30, 1993, we conducted risk assessments on 247 children tested for PbB.
Two hundred twenty-two of 3630 children (6.1%) had a PbB of 10 micrograms/dL or greater. Thirty-nine (1.1%) had a PbB at least 20 micrograms/dL. Seventy-nine percent of the children screened and 91.0% of the children with PbB at least 10 micrograms/dL were Hispanic. Twenty percent of Mexican-born Hispanic children had a PbB of 10 micrograms/dL or greater, versus 7% of U.S.-born Hispanic children. Several factors were associated with elevated PbB among Hispanic children. For identifying children with a PbB of at least 10 micrograms/dL, the sensitivity and predictive value negative for the CDC's "high risk" definition were 30% and 93%, respectively, whereas for the SCC population-specific high-risk definition, the sensitivity was 90% and the predictive value negative was 98%.
Hispanic children attending SCC public clinics have risk factors for elevated PbB that were not included in the CDC's lead poisoning questionnaire. Methods for prioritizing the frequency of lead screening may be improved by combining the CDC's questions with a population-specific risk assessment.
确定：（1）在加利福尼亚州圣克拉拉县（SCC）公共诊所就诊的6至72个月大儿童中，血铅水平（PbB）达到或高于10微克/分升以及达到或高于20微克/分升的患病率；（2）该人群中血铅水平升高的危险因素；（3）SCC公共诊所特定人群风险评估工具以及美国疾病控制与预防中心开发的五题式铅中毒调查问卷对于前瞻性识别血铅水平升高风险较高儿童是否有用。
我们对1991年8月8日至1992年9月1日期间在SCC公共门诊就诊的3630名6至72个月大儿童进行了血铅检测。然后我们开展了两项匹配病例对照研究。将五个当地危险因素问题与疾病控制与预防中心的五题式铅中毒调查问卷相结合，在1993年5月1日至1993年6月30日期间，我们对247名接受血铅检测的儿童进行了风险评估。
3630名儿童中有222名（6.1%）血铅水平达到或高于10微克/分升。39名（1.1%）血铅水平至少为20微克/分升。接受筛查的儿童中有79%以及血铅水平至少为10微克/分升的儿童中有91.0%为西班牙裔。出生在墨西哥的西班牙裔儿童中有20%血铅水平达到或高于10微克/分升，而在美国出生的西班牙裔儿童中这一比例为7%。西班牙裔儿童中，有几个因素与血铅水平升高相关。对于识别血铅水平至少为10微克/分升的儿童，疾病控制与预防中心“高风险”定义的敏感度和阴性预测值分别为30%和93%，而对于SCC特定人群高风险定义，敏感度为90%，阴性预测值为98%。
在SCC公共诊所就诊的西班牙裔儿童存在血铅水平升高的危险因素，这些因素未包含在疾病控制与预防中心的铅中毒调查问卷中。将疾病控制与预防中心的问题与特定人群风险评估相结合，可能会改进铅筛查频率的优先排序方法。
