Statewide assessment of lead poisoning and exposure risk among children receiving Medicaid services in Alaska.

OBJECTIVE

Lead poisoning is a well-recognized public health concern for children living in the United States. In 1992, Health Care Financing Administration (HCFA) regulations required lead poisoning risk assessment and blood lead testing for all Medicaid-enrolled children ages 6 months to 6 years. This study estimated the prevalence of blood lead levels (BLLs) >/=10 microg/dL (>/=0.48 micromol/L) and the performance of risk assessment questions among children receiving Medicaid services in Alaska.

DESIGN

Measurement of venous BLLs in a statewide sample of children and risk assessment using a questionnaire modified from HCFA sample questions.

SETTING

Eight urban areas and 25 rural villages throughout Alaska.

PATIENTS

Nine hundred sixty-seven children enrolled in Medicaid, representing a 6% sample of 6-month- to 6-year-old Alaska children enrolled in Medicaid.

OUTCOME MEASURE(S): Determination of BLL and responses to verbal-risk assessment questions.

RESULTS

BLLs ranged from <1 microg/dL (<0.048 micromol/L) to 21 microg/dL (1.01 micromol/L) (median, 2.0 microg/dL or 0.096 micromol/L). The geometric mean BLLs for rural and urban children were 2.2 microg/dL (0.106 micromol/L) and 1.5 microg/dL (0.072 micromol/L), respectively. Six (0.6%) children had a BLL >/=10 microg/dL; only one child had a BLL >/=10 microg/dL (11 microg/dL or 0.53 micromol/L) on retesting. Children whose parents responded positively to at least one risk factor question were more likely to have a BLL >/=10 microg/dL (prevalence ratio = 3.1; 95% confidence interval = 0.4 to 26.6); the predictive value of a positive response was <1%.

CONCLUSIONS

In this population, the prevalence of lead exposure was very low (0.6%); only one child tested (0.1%) maintained a BLL >/=10 microg/dL on confirmatory testing; no children were identified who needed individual medical or environmental management for lead exposure. Universal lead screening for Medicaid-enrolled children is not an effective use of public health resources in Alaska. Our findings identify an example of the importance in considering local and regional differences when formulating screening recommendations and regulations, and continually reevaluating the usefulness of federal regulations.