A comparison of elevated blood lead levels among children living in fostercare, their siblings, and the general population

Objectives. To assess the prevalence of elevated blood lead levels (EBLLs) among children before and after foster care placement, and to compare the p revalence of EBLLs among children in foster care with that of their sibling s and the general population. Methods. We conducted a retrospective cohort study using administrative dat abases from the Philadelphia Department of Human Services and the Birth Cer tificate Registry and the Childhood Lead Poisoning Prevention Program at th e Philadelphia Department of Public Health. Logistic regression analyses we re performed to control for confounding variables, including age, race, gen der, and the year, seasonal timing, and source (capillary vs venous) of tes t. Results. From June 1992 to May 1997, there were 1824 children in foster car e with available blood lead results in the Childhood Lead Poisoning Prevent ion Program database. Of these, 519 (28%) had initial lead screening before foster care placement and 654 (36%) after placement. There were 821 siblin gs and 73 608 children in the general population with available blood lead results. Before entering foster care, children were nearly twice as likely to have E BLLs as their siblings (adjusted odds ratio [OR] = 1.7; 95% confidence inte rval [CI] = 1.4, 2.0), those in placement (adjusted OR = 1.9; 95% CI = 1.6, 2.2), and the general population (adjusted OR = 1.7; 95% CI = 1.5, 2.0). A t the highest point prevalence, 50% of children before placement had lead l evels greater than or equal to 20 mug/dL, and nearly 90% had levels greater than or equal to 10 mug/dL. For all age categories, siblings of children i n foster care placement had a higher prevalence of EBLLs than did the gener al population. After placement, children in foster care were nearly half as likely as the other groups to have EBLLs. Conclusions. Our findings suggest that children are at high risk for lead p oisoning before entering foster care and that placement in foster care may have a beneficial effect on lead exposure. Children before foster care plac ement are nearly twice as likely to have EBLLs compared with children in fo ster care placement, the general population, and their siblings. Furthermor e, siblings of children in foster care are at high risk for lead poisoning. Children receiving social services in their own homes and children sufferi ng from abuse and neglect should be actively screened for lead poisoning. G reater efforts at preventing lead poisoning among these children must be ma de.