Objective: To evaluate the prevalence of vitamin D deficiency and insufficiency, as well as their association with Hb and elevated blood lead levels (BLL) in children in China. Design: A cross-sectional and 1-year retrospective study. Setting: Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, China. Subjects: Children aged from 6 months to 14 years living in south-west China who were taken to physical examinations (January-December 2011). Results: Of 1218 children included in the study, 25-hydroxyvitamin D (25(OH)D) concentration (mean 33?18 (SD 16?48) ng/ml) was deficient in 21?6 % and insufficient in 27?4 %, which were higher than the prevalence of both anaemia at 8?5 % and elevated BLL (Pb $ 10 mg/dl) at 1?8 %, but lower than mildly elevated BLL prevalence (5 mg/dl # Pb , 10 mg/dl) at 56?9 %. There was a negative correlation between 25(OH)D concentration and BLL (r 5 20?216, P , 0?001) while no significant relationship was found between 25(OH)D concentration and Hb (r 5 20?012, P . 0?05). After multivariable adjustment, the significant predictors of 25(OH)D deficiency and insufficiency were increasing child age especially between 8 and 14 years (OR 5 18?29; 95 % CI 10?14, 32?99; P , 0?001) and BLL (OR 5 1?01; 95 % CI 1?00, 1?02; P 5 0?045). Conclusions: The prevalence of 25(OH)D deficiency and insufficiency was much higher than that of anaemia or elevated BLL in south-west China, and associated with increasing age and BLL.