Lead is among the most common environmental toxins for young children in New York State (NYS). Lead poisoning is associated with serious and lifelong adverse health, developmental and cognitive outcomes that are completely preventable. New York State is committed to achieving the goal of eliminating childhood lead poisoning by the year 2010. Elimination of childhood lead poisoning is essential to improving the lives of children in NYS, especially socio-economically disadvantaged children who are disproportionately affected by lead poisoning. New York has made significant progress towards reducing both the incidence and severity of childhood lead poisoning. Despite this success, childhood lead poisoning remains a serious public health problem.
The majority of children with lead poisoning are exposed to lead from deteriorating lead paint in their homes. New York State has the largest number and percent of pre-1950 housing of all states in the nation.1 Additional sources of lead exposure may include lead-contaminated soil and water, imported food, pottery and cosmetics, traditional medicines and some imported children's toys and jewelry. Children may also be exposed to lead if their parents or guardians have occupations or hobbies that expose them to lead. Because medical treatment options for lead poisoning are limited, it is critical that children be protected from lead exposure before they become lead poisoned.
Under current NYS Public Health Law and implementing regulations, health care providers are required to test all children for lead at or around age one year and again at or around age two years. Health care providers are also required to assess all children age six months to 72 months of age at least once annually for lead exposure, with blood lead testing for all children found to be at risk, based on those assessments. Early identification of children with elevated blood lead levels through routine blood lead testing is essential to assure coordination of follow up services to minimize harmful effects and prevent further exposure to lead.
The analysis and application of data are important tools used by the New York State Department of Health (the Department) to assess the extent of the childhood lead poisoning problem, to identify high-risk communities and populations with the highest need for interventions, and to monitor and evaluate the effectiveness of interventions. Eliminating Childhood Lead Poisoning in New York State summarizes the status of childhood testing and lead poisoning in NYS, excluding New York City (NYC) for children less than six years of age.2 This surveillance report contains several new measures to more effectively assess and monitor progress toward the elimination of childhood lead poisoning by 2010. Historical data have been included to show trends over time for these new measures.
New York State has made significant gains in the prevention, early identification and effective management of childhood lead poisoning. The State and Local Health Departments, in collaboration with a wide range of partners, are working to continue the positive trends described in this report through the development and implementation of effective public health strategies. Additional information on these efforts may be found in New York's strategic plan, Eliminating Childhood Lead Poisoning in New York State by 2010.
This report highlights a number of important findings for New York State (excluding New York City):
- Lead testing rates for children at or around age one year are improving. A 22.7 percent increase in blood lead testing rates for children at or around age one year was observed among children born in 2004 compared to children born in 1998. Approximately 60 percent of children born in 2004 were tested for lead at or around age one year, compared to 49.4 percent of children born in 1998.
- Lead testing rates for children tested at or around age two years are improving. A 33.7 percent increase in blood lead testing rates for children at or around age two years was observed among children born in 2004 compared to children born in 1998. Almost 52 percent of children born in 2004 were tested for lead at or around age two, compared to 38.6 percent of children born in 1998. Although lead testing rates for two-year old children are improving, the percentage of children tested at age two years is lower than the percentage tested at age one year.
- A high percent of children receive at least one blood lead test by age three years, but fewer receive two or more tests by age three years. Of children born in NYS in 2004, 82.8 percent received at least one lead test by age 36 months. Although the percent of children receiving at least two lead tests by age three years is significantly lower than the percent of children receiving at least one test by age three years, trend data indicate this measure is improving. The number of children receiving two blood lead tests by age three years increased 62.0 percent over the past seven years, from 27,321 children born in 1998 to 44,261 children born in 2004 (data not shown). The percent of children who received at least two tests by age three years increased from 26.8 percent of children born in 1998 to 40.8 percent of children born in 2004.
- The incidence of elevated blood lead levels (EBLLs) among children under age six years is steadily declining across all blood lead level (BLL) categories. Incidence data reflect new cases of lead poisoning and first identified within a given yearrend data show the dramatic improvement in both the number and percent of children identified with confirmed BLLs ≥ 10 mcg/dL, the current definition of lead poisoning established by the federal Centers for Disease Control (CDC) and Prevention. In 1998, 5,198 children less than six years of age were newly identified with BLLs ≥ 10mcg/dL, compared to 1,901 children in 2007. This represents a striking 63.4 percent decline in the number of children with EBLLs since 1998. A 68.3 percent decrease in the rate of incidence of lead poisoning was observed over the same time period, from 29.0 per 1,000 children tested in 1998 to 9.2 per 1,000 children tested in 2007.
- The incidence of childhood lead poisoning varies across the state. For the three-year period from 2005 through 2007, 65.9 percent of incident cases outside of NYC of children newly identified with BLLs ≥ 10 mcg/dL resided in the eight highest upstate incidence counties: Erie, Monroe, Onondaga, Westchester, Oneida, Orange, Albany and Nassau.
- The prevalence of elevated blood lead levels among children under age six years continues to decline. Prevalence data reflect both new and ongoing cases of lead poisoning. rend data show a significant improvement in both the total number and percentage of children under age six years with BLLs ≥ 10 mcg/dL in NYS. In 1998, 10,155 children less than six years of age had BLLs ≥ 10mcg/dL compared to 2,947 children in 2007, representing a 71.0 percent decline. A 73.7 percent decrease in prevalence rates was observed over the past seven years; from 53.3 per 1,000 children tested in 1998 to 14.0 per 1,000 children tested in 2007.
- The number and proportion of children with blood lead levels 5 - 9 mcg/dL are also declining. A growing body of scientific evidence highlights concerns about the harmful effects of blood lead levels below 10 mcg/dL, the blood lead level established by the Centers for Disease Control and Prevention (CDC) as the definition of lead poisoning and the trigger for medical and public health interventions. In 2007, a total of 20,343 children under the age of six years had blood lead levels of 5 - 9 mcg/dL, representing 9.8 percent of all children under age six who were tested for lead that year. Trend data show that the number and percent of children with blood lead levels in this range are declining over time, paralleling declines in elevated blood lead levels. A new analysis of "serial" blood lead testing results demonstrates that 8.5 percent of children who had a BLL of 5 - 9 mcg/dL when tested at age one year went on to have a BLL of 10 mcg/dL or higher when tested at age two.
- 2000 Census Summary File 3 data
- The New York City Department of Health and Mental Hygiene (NYCDOHMH) has released annual reports for New York City 2006 and 2007 blood lead surveillance data entitled "Preventing Lead Poisoning in New York City". These reports may be accessed on line at http://www.nyc.gov/lead. The full reports may be obtained by contacting the NYCDOHMH Lead Poisoning Prevention Program's Education Unit.