RURAL-URBAN BLOOD LEAD DIFFERENCES IN NORTH-CAROLINA CHILDREN

Objective. To examine the prevalence of and risk factors for having a blood lead elevation among young children in a predominantly rural sta te. Methods. 20 720 North Carolina children at least 6 months and <6 y ears of age were screened between November 1, 1992 and April 30, 1993 using either capillary or venous measurements of blood lead. Children were tested through routine screening programs that target low-income families and, hence, were not randomly selected. Eighty-one percent of the children were screened through local public health departments, a nd 19% were tested at private clinics. Results. The estimated prevalen ces of having an elevated blood lead level among those tested were: 20 .2% (greater than or equal to 10 mu g/dL), 3.2% (greater than or equal to 15 mu g/dL), and 1.1% (greater than or equal to 20 mu g/dL). Black children were at substantially increased risk of having a blood lead greater than or equal to 15 mu g/dL (odds ratio (OR) = 2.1, 95% confid ence interval (CI) = 1.7 to 2.5). Children aged 2 years old had an ele vated risk (OR = 1.4, 95% CI = 1.1 to 1.7) compared to 1-year-olds, an d males were at slightly increased risk (OR = 1.2, 95% CI = 1.0 to 1.4 ). Living in a rural county was nearly as strong a risk factor as race (OR = 1.9, 95% CI = 1.6 to 2.4). The effect of rural residence was ev en greater among certain subgroups of children already at highest risk of having an elevated blood lead. The type of clinic (public vs priva te) where a child was screened was not associated with blood lead outc ome. These same trends were seen for children with blood lead levels g reater than or equal to 20 mu g/dL. Conclusions. Among children screen ed from rural communities, the prevalence of elevated blood lead is su rprisingly high. Though few physicians have embraced universal lead sc reening, these data support the need for greater awareness of lead exp osure in children living outside of inner-cities.