ADVANCEMENT OF THE SCIENCE
Open Access
The Impact of Poverty Status on Blood Lead Levels Among Individuals in the United States From 2017–2018: An Analysis of the National Health and Nutrition Examination Survey b:;r*,; This cross-sectional study examines the population prevalence of blood lead levels (BLLs) greater than the sample median of 0.76 μg/dl in the U.S. population and investigates demographic factors as- sociated with higher BLLs using data from the 2017–2018 National Health and Nutrition Examination Survey. Logistic regression models were used to assess the impact of poverty status on BLLs, with adjustments for factors such as race, age, gender, and lifetime smoking history. This study found that individuals living in or near poverty had significantly higher odds of having a BLL >0.76 μg/dl when compared with individuals not in poverty, with an adjusted OR of 1.824 (95% CI [1.324, 2.513]) and 1.744 (95% CI [1.388, 2.190]), respectively. This nationally representative study has important implications for understanding the demographic and socioeco- nomic factors that aect BLLs in the U.S. population. Keywords: blood lead level, lead, poverty, environmental justice, environ- ment, regression
Michael Ricciardi, MPH
with a lower economic status, it is reason- able to assume that there is greater exposure to lead in individuals of lower income brack- ets. Moreover, dierences in BLL by ethnic- ity, gender, and age have been described, with Black children having the highest BLLs on average (Bernard & McGeehin, 2003; Kurtin et al., 1997). Additionally, research has dem- onstrated increased BLLs in individuals who smoke cigarettes (Shaper et al., 1982). When considering the health eects of lead, it is widely understood that lead expo- sure, even at moderate levels, has detrimen- tal eects on multiple body systems (ATSDR, 2020). The most commonly understood eect of lead exposure is likely a decrease in cognitive function. Research has shown a significant negative association between lead poisoning and social, behavioral, and intel- lectual development (Hou et al., 2013). Fur- ther, a literature review by Vorvolakos et al. (2016) associates lead with the development of schizophrenia, anxiety, and depression. Along with this finding, research has shown that lead exposure in childhood results in impaired cognitive development that can persist over time, as well as increased risks for Alzheimer’s disease and other degen- erative brain conditions (Koshy et al., 2020; Peters et al., 2010; Reuben, 2018). Aside from its impact on cognition, lead exposure has also been implicated in a myr- iad of diseases and conditions not related to cognition. For one, maternal BLLs and cord BLLs have shown a strong, significant nega- tive association with birthweight (Wang et al., 2020), and there is evidence that mater- nal BLL negatively impacts fetal ossifica- tion (Saleh et al., 2009).A dose-dependent relationship between lead and bone mineral density has also been described, with sig- nificant decreases in bone mineral density
Introduction Lead is a toxic heavy metal that has been recognized for many decades as a significant environmental and public health hazard. Lead is present in the environment as a naturally occurring metal in ore deposits around the world, but these sources of lead do not pose much of a threat to human health. The pub- lic health concern for lead exposure arises when considering the various anthropogenic sources of lead, which include paints, pipes, batteries, solder, pesticides, and lead smelter- ies. Before 1995, when leaded gasoline was still in use, its combustion was a major source of lead exposure for people in the U.S. (Agency for Toxic Substances and Disease Registry [ATSDR], 2020). Of note is the concern for atmospheric deposition of lead into soil, which can contribute to exposure from nonlo- cal sources (ATSDR, 2020). A pooled analysis
concluded that lead-contaminated house dust is the major source of lead exposure for chil- dren (Lanphear et al., 1998). While lead-based paints are no longer in use, homes built before 1978 continue to carry a risk of the deposition of lead into household dust due to paint dete- rioration (ATSDR, 2020). Many factors that increase the risk of exposure to lead have been identified. For example, children living in low- and middle- income countries have been found to have a high prevalence of blood lead levels (BLLs) that exceed the 5 μg/dl threshold set by the Centers for Disease Control and Prevention (Ericson et al., 2021). Infants and toddlers have much more frequent hand-to-mouth behavior, which places them at a higher risk of ingesting lead dust in older homes (ATSDR, 2020). As these older homes are more likely to be occupied by individuals
8
Volume 86 • Number 9
Powered by FlippingBook