Elevated Blood Lead Levels by Length of Time From Resettlement to Health Screening in Kentucky Refugee Children

Kotey, Stanley; Carrico, Ruth; Wiemken, Timothy; Furmanek, Stephen; Bosson, Rahel; Nyantakyi, Florence; VanHeiden, Sarah; Mattingly, William A.; Zierold, Kristina M.

doi:10.2105/ajph.2017.304115

Cited by 13 publications

(16 citation statements)

References 16 publications

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“…A cross-sectional study of Greek children found BPb ≥5 µg/dL among 27.7% of migrants but only 1.2% of natives 18. Multiple cross-sectional analyses in the USA have identified that newcomer refugee children settling in Florida,33 Kentucky34 and New Hampshire14 were significantly more likely to have elevated BPb compared with native children. Additionally, a case–control study of 203 children matched on age, date of test and residential area in New York City found an elevated risk of lead poisoning in foreign-born children relative to US-born children (OR 10.9; 95% CI 3.3 to 36.5) 11…”

Section: Discussionmentioning

confidence: 99%

Association between self-reported length of time in the USA and blood lead levels: National Health and Nutrition Examination Survey 2013–2016

2019

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ObjectivesThe aim of this study is to determine the association between length of time in the USA with blood lead (BPb).DesignPopulation-based cross-sectional study using data from the 2013–2016 National Health and Nutrition Examination Survey.SettingUSA.Participants5933 men and women (≥15 years); subgroups of men only (n=2867), women only (n=3064) and women of childbearing age (15–45 years) (n=1580).Primary and secondary outcomesThe primary outcome was BPb concentration. The main exposure variable was self-reported number of years spent in the USA, categorised as: born in the USA; 0–4 years; 5–9 years; 10–19 years and ≥20 years. We used linear regression models adjusted for race/ethnicity, education, blood cotinine, age, sex (as appropriate) and accounted for complex survey design.ResultsWomen of childbearing age who have lived 0–4 years in the USA have, on average, a 54% (95% CI 36% to 75%) higher BPb compared with women born in the USA. Corresponding results for all women, men and the entire population were 49% (95% CI 34% to 66%), 49% (95% CI 28% to 75%) and 49% (95% CI 33% to 66%), respectively. Similar, statistically significant, results were observed for other time periods (5–9 years, 10–19 years and ≥20 years); the magnitude of the association decreased with increasing time in the USA.ConclusionsThis study provides additional evidence that newcomers to the USA may be a population at higher risk of elevated BPb.

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Section: Discussionmentioning

confidence: 99%

Association between self-reported length of time in the USA and blood lead levels: National Health and Nutrition Examination Survey 2013–2016

2019

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“…Furthermore, three issues that are related to lead exposure in LMICs deserve attention. First, a number of studies have documented elevated BLLs among refugees, either prior to or after settling in the U.S. [ 7 , 8 , 9 , 10 , 11 , 12 ]. These statistics underscore the fact that the global problem of lead can take on very local meaning outside of the countries of origin.…”

Section: Exposure Patternsmentioning

confidence: 99%

Lead Exposure in Low and Middle-Income Countries: Perspectives and Lessons on Patterns, Injustices, Economics, and Politics

Kordas

Ravenscroft

Cao

et al. 2018

IJERPH

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Lead exposure is a legacy issue that continues to affect vulnerable population groups globally, but particularly in low and middle-income countries (LMICS). We take a multi-disciplinary approach to examine the patterns of lead exposure in these countries, discuss the underlying injustices and socio-political causes, and the economic costs that are associated with exposure. We conclude with some lessons we drew from our discussion of lead across the disciplines and advocate for a number of approaches to solving this ongoing issue. These include (i) biomonitoring that could be integrated into existing health surveys or public health programs targeting young children; (ii) greater civic engagement to push for solutions; and, (iii) environmental control policies that represent a continuum of local, context-specific to broad, national-level, and even global approaches.

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“…2 Subsequent reports have confirmed this health concern for refugee populations. [3][4][5][6][7][8] For example, an investigation by the Centers for Disease Control and Prevention (CDC), published in 2004, determined that African refugee children with histories of malnourishment who were resettled in New Hampshire were more susceptible to environmental lead exposure than US-born children living in the same housing development. 3 A 2011 report on Burmese refugee children resettled in Indiana showed a high prevalence of EBLLs that was associated with culturally traditional cosmetic use in the home.…”

mentioning

confidence: 99%

“…7 A 2018 study of refugee children resettled in Kentucky also showed that EBLLs were associated with older housing, and that although blood lead levels (BLLs) were initially high, they did decline in some refugees after resettlement in the United States. 8 Although CDC specifies that no amount of lead in the blood is safe or acceptable, historically it had defined EBLLs as being !10 mg/dL. Before 2012, however, research suggested that lower BLLs could cause irreversible harm to young children, particularly to their neurocognitive development.…”

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Trends in Elevated Blood Lead Levels Using 5 and 10 µg/dL Levels of Concern Among Refugee Children Resettled in Massachusetts, 1998-2015

2019

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Objectives: Refugee children are known to have a high prevalence of elevated blood lead levels (EBLLs). We sought to determine trends in EBLLs among refugee children during an 18-year period and examine relationships between descriptive characteristics and EBLLs by using 10 µg/dL and 5 µg/dL levels of concern. Methods: We retrospectively evaluated refugee health screening data from Massachusetts for 1998 through 2015 for refugee children aged <7 years. We performed bivariate and multivariate analyses of variables including sex, age, region of origin, anemia, intestinal parasites, tuberculosis test results, and anthropometric measurements and used both 5 µg/dL and 10 µg/dL levels of concern for EBLLs. Results: Of 3421 eligible refugee children, 3054 (88.2%) were tested. Using 5 µg/dL and 10 µg/dL levels of concern, 1279 (41.9%) and 241 (7.9%) children, respectively, had EBLLs. Mean BLLs declined steadily from 7.58 µg/dL in 2004 to 4.03 µg/dL in 2015. African (adjusted odds ratio [aOR] = 2.49; 95% confidence interval [CI], 1.81-3.43), East Asian and Pacific (aOR = 1.98; 95% CI, 1.35-2.91), and South-Central Asian (aOR = 2.47; 95% CI, 1.53-4.01) regions of origin and anemia (aOR = 1.50; 95% CI, 1.14 -1.97) were significantly associated with BLLs ≥5 µg/dL. Conclusions: The prevalence of EBLLs among refugees compared with US-born children is high. Because EBBLs increase the risk for neurocognitive impairment in children, public health professionals, policy makers, researchers, refugee resettlement staff members, and health care providers must remain vigilant in screening for lead poisoning and educating refugees about the hazards posed to young children by lead.

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Elevated Blood Lead Levels by Length of Time From Resettlement to Health Screening in Kentucky Refugee Children

Abstract: Elevated blood lead levels were reduced with increasing length of time of resettlement in unadjusted and adjusted models. Improved housing, early education, and effective safe-house inspections may be necessary to address EBLLs in refugees.

Cited by 13 publications

References 16 publications

Association between self-reported length of time in the USA and blood lead levels: National Health and Nutrition Examination Survey 2013–2016

Association between self-reported length of time in the USA and blood lead levels: National Health and Nutrition Examination Survey 2013–2016

Lead Exposure in Low and Middle-Income Countries: Perspectives and Lessons on Patterns, Injustices, Economics, and Politics

Trends in Elevated Blood Lead Levels Using 5 and 10 µg/dL Levels of Concern Among Refugee Children Resettled in Massachusetts, 1998-2015

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