Blood Lead Testing Among Medically Underserved and Socially Vulnerable Children in the United States 2012-2017

Abstract

Context: Lead poisoning can affect intellectual development, growth, hearing, and other health problems. Children 6 years or younger are particularly susceptible to lead poisoning. Health Resources and Services Administration (HRSA)-funded health centers (HCs) serve lower-income, minority, and vulnerable populations across the United States, who may be at a higher risk for lead exposure. At HCs, blood lead testing is monitored; however, little is known about testing rates and characteristics of children tested by HCs. Objectives: We assessed the prevalence and characteristics of children who received a blood lead test at HCs from 2012 to 2017. Design: We assessed characteristics of children 12 to 60 months of age who had a blood lead test using available selfreported data from HRSA's Health Center Patient Survey (2014)(2015). In addition, using HRSA's Uniform Data System, an administrative performance data set, we calculated the annual percentage change of blood lead testing from 2012 to 2017. Results: During 2014-2015, 1.1 million (72.9%; 95% CI, 64.6-81.3) out of the 1.5 million (n = 365 unweighted) eligible children 12 to 60 months of age self-reported receiving a blood lead test at an HRSA-funded HC. There was a significant higher proportion of children with a blood lead test among urban HCs (74.1%; 95% CI, 59.4-88.8) and among those who reported HCs as their usual source of care (99.9%; 95% CI, 99.7-100) (P ≤ .05). The total HC population of children younger than 72 months increased from 2 674 500 in 2012 to 2 989 184 in 2017, and we observed a 34.4% increase in blood lead testing at HRSA-funded HCs over the same time period. Conclusions: HCs play an important role in providing access to blood lead testing in underserved communities in the United States. While HRSA-funded HCs have made substantial efforts to screen and educate patients on lead exposure, nonetheless continued screening and education efforts with both health providers at HCs and parents/guardians are warranted to continue to improve blood lead screening rates among high-risk groups.