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Int. J. Environ. Res. Public Health 2015, 12(12), 15366-15378; doi:10.3390/ijerph121214989

Screening for Elevated Blood Lead Levels in Children: Assessment of Criteria and a Proposal for New Ones in France

1
INSERM (National Institute of Health and Medical Research) U1085, Irset-Environmental and Occupational Health Research Institute, Rennes 35043, France
2
EHESP (School of Public Health), Sorbonne Paris Cité, Rennes 35043, France
3
InVS—French Institute for Public Health Surveillance, Saint Maurice 94415, France
4
Ministry of Health, Directorate for Health, Paris 75350, France
*
Author to whom correspondence should be addressed.
Academic Editor: Howard W. Mielke
Received: 9 September 2015 / Revised: 20 November 2015 / Accepted: 24 November 2015 / Published: 3 December 2015
(This article belongs to the Special Issue Lead: Risk Assessment and Health Effects)
View Full-Text   |   Download PDF [333 KB, uploaded 3 December 2015]   |  

Abstract

The decline in children’s Blood Lead Levels (BLL) raises questions about the ability of current lead poisoning screening criteria to identify those children most exposed. The objectives of the study were to evaluate the performance of current screening criteria in identifying children with blood lead levels higher than 50 µg/L in France, and to propose new criteria. Data from a national French survey, conducted among 3831 children aged 6 months to 6 years in 2008–2009 were used. The sensitivity and specificity of the current criteria in predicting blood lead levels higher than or equal to 50 µg/L were evaluated. Two predictive models of BLL above 44 µg/L (for lack of sufficient sample size at 50 µg/L) were built: the first using current criteria, and the second using newly identified risk factors. For each model, performance was studied by calculating the area under the ROC (Receiver Operating Characteristic) curve. The sensitivity of current criteria for detecting BLL higher than or equal to 50 µg/L was 0.51 (0.26; 0.75) and specificity was 0.66 (0.62; 0.70). The new model included the following criteria: foreign child newly arrived in France, mother born abroad, consumption of tap water in the presence of lead pipes, pre-1949 housing, period of construction of housing unknown, presence of peeling paint, parental smoking at home, occupancy rates for housing and child’s address in a cadastral municipality or census block comprising more than 6% of housing that is potentially unfit and built pre-1949. The area under the ROC curve was 0.86 for the new model, versus 0.76 for the current one. The lead poisoning screening criteria should be updated. The risk of industrial, occupational and hobby-related exposure could not be assessed in this study, but should be kept as screening criteria. View Full-Text
Keywords: lead poisoning; exposure; health; child; screening evaluation lead poisoning; exposure; health; child; screening evaluation
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Etchevers, A.; Glorennec, P.; Le Strat, Y.; Lecoffre, C.; Bretin, P.; Le Tertre, A. Screening for Elevated Blood Lead Levels in Children: Assessment of Criteria and a Proposal for New Ones in France. Int. J. Environ. Res. Public Health 2015, 12, 15366-15378.

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