IDENTIFICATION OF CHILDREN AT RISK FOR LEAD-POISONING - AN EVALUATIONOF ROUTINE PEDIATRIC BLOOD LEAD SCREENING IN AN HMO-INSURED POPULATION

Objectives. To estimate the prevalence of elevated blood lead levels i n children receiving well-care checkups; and to evaluate the effective ness of certain key risk factors in detecting children at higher risk for elevated blood lead levels. Design. Cross-sectional study. Setting . Two facilities of the Kaiser Permanente Medical Care Program (KPMCP) health maintenance organization (HMO), northern California region. Pa tients. Six hundred thirty-six children, aged 12 to 60 months, who wer e seen at four KPMCP facilities in two subregions for a well-care chec kup from September 1991 through August 1992. Interventions. Blood samp les were collected from each child and analyzed for lead content. Part icipating parents completed a questionnaire that included questions re commended by the Centers for Disease Control and Prevention (CDC) abou t the child's and the parents' lead exposure via home, workplace, and hobbies. Results. Ninety-six percent of the children had blood lead le vels under 10 mu g/dL. Blood lead levels declined with increasing age and were higher for black children compared with whites. Age of reside ntial housing, mother's education, and residence in an old house with peeling paint had low sensitivity and positive predictive value for id entifying children with blood lead levels over 10 mu g/dL. Conclusion. Universal routine screening for elevated blood lead levels in childre n in an employed, HMO-insured population is not warranted on grounds o f prevalence. Responses to CDC questions do not effectively identify h igh-risk children in this population.