LEAD-POISONING AMONG LOW-INCOME CHILDREN IN ORANGE-COUNTY, CALIFORNIA- A NEED FOR REGIONALLY DIFFERENTIATED POLICY

Objective.-To estimate the prevalence of elevated lead levels among ch ildren in Orange County, California, and to evaluate the appropriatene ss of a universal pediatric blood lead screening policy in this commun ity. Design.-Venous blood lead testing was conducted and results were analyzed according to seven blood lead strata ranging from less than 0 .50 mumol/L (10 mug/dL) to 3.35 mumol/L (70 mug/dL) or higher. A cost analysis of the lead-testing program in Orange County was conducted. S etting.-Children meeting poverty eligibility criteria and attending th e Child Health and Disability Prevention Program, the state's implemen tation of the federal Early and Periodic Screening, Diagnosis and Trea tment (EPSDT) services program. Participants.-A total of 5115 Orange C ounty children between 12 and 72 months of age using EPSDT services fr om March through December 1992. Main Outcome Measures.-Blood lead leve ls and associated costs of the testing program stratified by level of blood lead elevation. Results.-Blood lead levels of 0.50 mumol/L (10 m ug/dL) or higher were found in 371 children (7.25%; 95% confidence int erval, 6.66% to 7.85%), but only six children (0.12%; 95% confidence i nterval, 0.04% to 0.20%) had elevations greater than 1.20 mumol/L (25 mug/dL). Five children (83.3%) had histories of lead consumption unrel ated to ingestion of lead-containing paint but related to the use of l ead-containing folk remedies and cooking utensils. Costs for detection of children with blood levels elevated to 0.50 mumol/L (10 mug/dL) or higher was $310 per child and for levels of 1.20 mumol/L (25 mug/dL) or higher was $19 139 per child. Conclusions.-These data suggest that lead poisoning is not a major public health problem among Orange Count y children and detection of infrequent cases would involve a high cost per child. In jurisdictions with newer housing, initial screening for a history of possible lead exposure alone may offer reasonable effica cy that is cost-effective. The scope of lead-testing programs should b e determined according to local needs and conditions.