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Prevalence of Elevated Blood Lead Levels and Risk Factors Among Residents Younger Than 6 Years, Puerto Rico—2010

Dignam, Timothy PhD, MPH; García, Brenda Rivera DVM, MPH; De León, Maridali MPH; Curtis, Gerald BA, GISP (retired); Creanga, Andreea A. MD, PhD; Azofeifa, Alejandro DDS, MSc, MPH; O'Neill, Maureen MURP (retired); Blanton, Curtis MS; Kennedy, Chinaro DrPH, MPH; Rullán, Maria MD, MPH; Caldwell, Kathy PhD; Rullán, John MD, MPH; Brown, Mary Jean ScD, RN

Journal of Public Health Management and Practice: January/February 2016 - Volume 22 - Issue 1 - p E22–E35
doi: 10.1097/PHH.0000000000000224
Original Articles

Context: Limited data exist about blood lead levels (BLLs) and potential exposures among children living in Puerto Rico. The Puerto Rico Department of Health has no formal blood lead surveillance program.

Objectives: We assessed the prevalence of elevated BLLs (≥5 micrograms of lead per deciliter of blood), evaluated household environmental lead levels, and risk factors for BLL among children younger than 6 years of age living in Puerto Rico in 2010.

Methods: We used a population-based, cross-sectional sampling strategy to enroll an island-representative sample of Puerto Rican children younger than 6 years. We estimated the island-wide weighted prevalence of elevated BLLs and conducted bivariable and multivariable linear regression analyses to ascertain risk factors for elevated BLLs.

Results: The analytic data set included 355 households and 439 children younger than 6 years throughout Puerto Rico. The weighted geometric mean BLL of children younger than 6 years was 1.57 μg/dL (95% confidence interval [CI], 1.27-1.88). The weighted prevalence of children younger than 6 years with BLLs of 5 μg/dL or more was 3.18% (95% CI, 0.93-5.43) and for BLLs of 10 μg/dL or more was 0.50% (95% CI, 0-1.31). Higher mean BLLs were significantly associated with data collection during the summer months, a lead-related activity or hobby of anyone in the residence, and maternal education of less than 12 years. Few environmental lead hazards were identified.

Conclusions: The prevalence of elevated BLLs among Puerto Rican children younger than 6 years is comparable with the most recent (2007-2010) US national estimate (BLLs ≥5 μg/dL = 2.6% [95% CI = 1.6-4.0]). Our findings suggest that targeted screening of specific higher-risk groups of children younger than 6 years can replace island-wide or insurance-specific policies of mandatory blood lead testing in Puerto Rico.

This article describes prevalence of elevated blood lead levels and risk factors among children younger than 6 years in Puerto Rico in 2010.

Division of Emergency and Environmental Health Services, National Center for Environmental Health (Drs Dignam, Kennedy, and Brown and Mr Curtis), Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (Dr Creanga), Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities (Dr Azofeifa), Division of Global Health Protection, National Center for Global Health (Mr Blanton), and Division of Laboratory Sciences, National Center for Environmental Health (Dr Caldwell), Centers for Disease Control and Prevention, Atlanta, Georgia; Puerto Rico Department of Public Health, San Juan (Drs García and Rullán and Ms De León); and Environmental Protection Agency, Region 2, New York (Ms O'Neill).

Correspondence: Timothy Dignam, PhD, MPH, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-60, Atlanta, GA 30341 (

The project was funded by the US Environmental Protection Agency (Interagency Agreement no. CE-10-010) and the Centers for Disease Control and Prevention. The authors thank the following individuals for their dedication and hard work, making this project successful: Darielys Cordero, Catherine Chacin, Ahmad Baghal, Margie Walling, Encijar Hassan Ríos, Jeff Jarrett, Charles Dodson, Carrie Dooyema, Sharunda Buchanan, W. Dana Flanders, Concepción Q. Longo, Ginger Chew, Elizabeth Hunsperger, Kathy Seikel, Luz B. Mojica, Norma Díaz, Edna Díaz, Julio Cadiz, Sandra Claudio Luciano, Mildred Rivera Luna, Magaly Escalera, Rachel Avchen, Payal Shah, Arie Manangan, Jennifer Cruz (CRIM) Ulises Feliciano Troche (CRIM) and Olga Cruz.

The findings and conclusions in the report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

None of the authors have any potential competing financial interests regarding this submitted article.

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