Impact of the COVID-19 Pandemic on Childhood Lead Testing and Blood Lead Levels

Ryan C L Brewster; Amee D Azad; Keith Acosta; Amy Starmer; Eli Sprecher; Corinna Rea; Kathryn P Gray; Shannon Regan; Joseph Wilson; Frehiwot Bayuh; Noah Buncher; Marissa Hauptman

doi:10.1016/j.acap.2023.11.014

Impact of the COVID-19 Pandemic on Childhood Lead Testing and Blood Lead Levels

Acad Pediatr. 2023 Nov 17:S1876-2859(23)00418-7. doi: 10.1016/j.acap.2023.11.014. Online ahead of print.

Authors

Affiliations

¹ Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, KP Gray, S Reagan, F Bayuh, and M Hauptman), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (RCL Brewster and N Buncher), Boston Medical Center, Boston, Mass; Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, and M Hauptman), Harvard Medical School, Boston, Mass. Electronic address: ryan.brewster@childrens.harvard.edu.
² Department of Ophthalmology (AD Azad), Massachusetts Eye and Ear, Boston, Mass.
³ Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, KP Gray, S Reagan, F Bayuh, and M Hauptman), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, and M Hauptman), Harvard Medical School, Boston, Mass.
⁴ Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, KP Gray, S Reagan, F Bayuh, and M Hauptman), Boston Children's Hospital, Boston, Mass; Institutional Centers of Clinical and Translational Research (KP Gray), Boston Children's Hospital, Boston, Mass.
⁵ Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, KP Gray, S Reagan, F Bayuh, and M Hauptman), Boston Children's Hospital, Boston, Mass.
⁶ Harvard T.H. Chan School of Public Health (J Wilson), Boston, Mass.
⁷ Department of Pediatrics (RCL Brewster and N Buncher), Boston Medical Center, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (N Buncher and M Hauptman), Boston, Mass.
⁸ Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, KP Gray, S Reagan, F Bayuh, and M Hauptman), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (RCL Brewster, K Acosta, A Starmer, E Sprecher, C Rea, and M Hauptman), Harvard Medical School, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (PEHSU) (N Buncher and M Hauptman), Boston, Mass.

PMID: 37979935
DOI: 10.1016/j.acap.2023.11.014

Abstract

Objective: To evaluate the effect of the COVID-19 pandemic on childhood lead testing and blood lead levels.

Methods: A retrospective analysis of lead tests and results was performed across 3 urban medical centers during the pre-COVID-19 (March 10, 2019-March 9, 2020) and COVID-19 (March 10, 2020-March 10, 2022) periods. Interrupted time series analysis with quasi-Poisson regression was used to evaluate changes in lead testing between study periods. The relationship between sociodemographic features with detectable (≧2 µg/dL) and elevated (≧3.5 µg/dL) blood lead levels (BLLs) was assessed with multivariable logistic regression.

Results: Among a total of 16,364 lead tests across 10,362 patients, weekly testing rates significantly decreased during COVID-19 (relative risk (RR) 0.64, 95% (confidence interval) CI 0.53-0.78). Census tracts with the greatest proportion of pre-1950s housing had a stronger association with detectable BLLs during the COVID-19 period (pre-COVID-19 adjusted odds ratio (aOR) 1.73, 95% CI 1.35-2.20; aOR 2.58, 95% CI 2.13-3.12; interaction P value .014). When limited to 1 year following COVID-19 (March 10, 2020-March 10, 2021), the association between both elevated BLLs (pre-COVID-19: aOR 1.49, 95% CI 0.87-2.53; COVID-19: aOR 3.51, 95% CI 1.98-6.25; interaction P value .032) and detectable BLLs with pre-1950s housing were greater during the COVID-19 period (pre-COVID-19: aOR 1.73, 95% CI 1.35-2.20; COVID-19: aOR 2.56, 95% CI 1.95-3.34; interaction P value .034).

Conclusions: The COVID-19 pandemic led to a significant reduction in lead surveillance and magnified the effect of known risk factors for lead exposure. Concerted clinical, public health, and community advocacy are needed to address care gaps and excess cases of lead poisoning.

Keywords: environmental health; health equity; lead poisoning.

Grants and funding

K23 ES031663/ES/NIEHS NIH HHS/United States